Control of Cancer Pain by Epidural Infusion of Morphine

Ng, Waterman; Hughes, S.; Ws, Foster

doi:10.1097/00132586-199236030-00039

Cited by 6 publications

(9 citation statements)

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“…Brachial plexus injuries, nerve pressure palsies, stretch injuries and increased ventilation perfusion mismatch problems have all been documented as risks of this position [1]. This case adds thoracic outlet obstruction of the subclavian artery with limb ischaemia as a potential risk during park bench positioning.…”

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 80%

“…Dopamine was increased to 10 lg.kg.min )1 and the ST dipped to )3.5 mm. At this point, the blood pressure started dropping and the heart rate increased to 100 min ) 1 . An intra-aortic balloon was inserted, noradrenaline was started; subsequently transoesophageal echocardiography was performed.…”

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 95%

“…This case adds thoracic outlet obstruction of the subclavian artery with limb ischaemia as a potential risk during park bench positioning. .............................................................................................................................................................................................................. Epidural infusions can be used for the management of selected patients with difficult cancer pain [1][2][3][4]. In patients with infusions lasting more than a few days our experience suggests that pain generally does not recur immediately after catheter removal.…”

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 97%

“…The recommended dose of Intralipid 20% is of course 1.5 ml.kg )1 , not 1.5 mg.kg . Two recent case reports used an even higher dose of 3 ml.kg )1 of lipid with successful outcomes [1,2] so it seems that the key in treating this complication is the delivery of a large bolus of lipid early. Clearly 105 mg of lipid is likely to be insufficient!…”

Section: A Replymentioning

confidence: 99%

“…Patient positioning for neurosurgery poses many technical and physiological challenges for the anaesthetist [1]. Recommendations state that pulse oximetry and blood pressure should be monitored throughout [2].…”

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 99%

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Thoracic outlet obstruction during neurosurgical positioning

2008

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referring to the original articles, most of the references included by the authors and the AAGBI guidelines on the use of Intralipid for treatment of local anaesthetic toxicity, we found that all recommend the dose of Intralipid as 1.5 ml.kg )1 of 20% solution which amounts to 21 g for a 70-kg patient. Williamson and Haines mention a dose of 1.5 mg.kg )1 of Intralipid 20% which amounts to 105 mg for a 70-kg patient. There is a huge dose difference in the two mentioned dose regimens and it needs to be clarified that the dose recommended in all the references is ml.kg )1 of 20% Intralipid solution rather than mg.kg .

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Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 80%

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 95%

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 97%

Section: A Replymentioning

confidence: 99%

Section: Thoracic Outlet Obstruction During Neurosurgical Positioningmentioning

confidence: 99%

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Thoracic outlet obstruction during neurosurgical positioning

2008

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Complications of spinal opioid therapy: myoclonus, spastic muscle tone and spinal jerking

Kloke

Bingel

Seeber

1994

Support Care Cancer

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This study was made in order to define risk factors for patients requiring spinal opioid therapy developing painful spastic muscle tone together with myoclonus and spinal jerking (MSJ). The case histories of 75 patients, all receiving morphine spinally, were retrospectively analysed and, of these, 10 suffered from the MSJ syndrome. The following were taken as evaluation criteria: age, sex, performance status, duration and dosage of previous systemic and current spinal morphine therapy, concomitant analgesic and co-analgesic medication, pretreatment of the dorsal column and neurological dysfunction due to damage either of the nerval plexus or of the medulla spinalis. As a result, high spinal morphine doses in conjunction with pathological changes within the spine were shown to be risk factors for this syndrome. Changing from spinal to systemic morphine application or reduction of spinal doses together with the addition of systemic morphine led to complete recovery from MSJ. As underlying mechanism, an imbalance between the activity of spinal and central opioid receptors and/or toxic morphine effects on the medulla spinalis are discussed. In conclusion, great care should be taken when applying morphine to the spine in patients with neurological dysfunction due to an apparent pathology of the medulla spinalis, especially if large amounts of morphine are likely to be required. Some systemic application of morphine might reduce the risk of patients developing MSJ syndrome.

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Cathéters intrarachidiens: biomatériaux

Ranchère

1995

Doul. et Analg.

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Control of Cancer Pain by Epidural Infusion of Morphine

Cited by 6 publications

References 0 publications

Thoracic outlet obstruction during neurosurgical positioning

Thoracic outlet obstruction during neurosurgical positioning

Complications of spinal opioid therapy: myoclonus, spastic muscle tone and spinal jerking

Cathéters intrarachidiens: biomatériaux

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