<p>Intrathecal Morphine Infusion Therapy via a Percutaneous Port for Refractory Cancer Pain in China: An Efficacy, Safety and Cost Utilization Analysis</p>

Abstract

Purpose: Intrathecal morphine infusion therapy via a percutaneous port (IMITPP) has been used widely for its relatively low initial cost. However, there is scarce knowledge about IMITPP. In this study, we sought to evaluate efficacy, complications, and the interval required to achieve the cost equivalence of IMITPP in patients with refractory cancer pain in China. Patients and Methods: A retrospective chart review was conducted on cancer patients who had received IMITPP at our hospital between April 2017 and April 2019. Data from the numeric pain rating scale and Karnofsky performance scores, and complications and costs related to IMITPP were collected from medical records. Daily analgesic costs before and after IMITPP were calculated based on the doses of opioids on admission and at discharge, respectively. The doses of systemic opioids before IMITPP were stratified into very high doses [VHD, oral morphine equivalent dose (OMED) >599 mg/day], high doses (HD, 300 mg/day ≤ OMED ≤ 599 mg/day), and regular doses (RD, OMED < 300 mg/day). Results: Intrathecal morphine infusion therapy via a percutaneous port provided significant pain relief, but impaired activities of daily living in patients with refractory cancer pain. The commonly reported complications included nausea/vomiting and urinary retention, most of which were managed with symptomatic therapies. The median interval required to achieve cost equivalence was 11.44 months. The median intervals of VHD group and HD group were significantly shorter than that of RD group. Conclusion: Intrathecal morphine infusion therapy via a percutaneous port provided effective cancer pain management without causing serious complications. Patients with higher doses of systemic opioids would economically benefit from IMITPP in a shorter time.

Comparison of external system and implanted system in intrathecal therapy for refractory cancer pain in China: A retrospective study

“…The disadvantage of ITT via an external pump is that patients must wear an external drug infusion pump and receive meticulous injection site care such as daily injection site disinfection, change of the butterfly‐winged needle in each visit, and avoiding inadvertent catheter dislodgement or removal in daily life, which could impair the performance of daily activity and further influence life satisfaction and affective experience (Bhatia et al., 2013 ; De Andres et al., 2020 ). The present study shows that ITT via the external system had a trend to decrease patients’ KPS scores, which is in accordance with a previous study and further proves the disadvantage of ITT via the external system (Qin et al., 2020 ).…”

“…In the present study, the incidence of infection is very low in the external group and shows no significant difference as compared to the implanted group. This profits partly from the utilization of the subcutaneous port that avoids a direct connection between the external infusion system and the intrathecal space There is no significant difference in the incidences of adverse events between the external and implanted groups an interval of 2 weeks, care transitions in the long-term ITT, and the careful prevention measures in daily life (Qin et al, 2020). The most frequent surgical complication was post-dural puncture headache in both groups, which suggests no significant difference in the risk of pericatheter CSF leakage between the two ITT systems (Adler & Lotz, 2017;Peralta et al, 2020).…”

Effects of family integrated care on refractory cancer-related pain receiving intrathecal morphine pump therapy: a cohort study

“…In practice, many studies have revealed the significant effects of IMP on pain relief (8,(14)(15)(16). Meanwhile, IMP was reported to induce the improvement of physical status, like the results in our study (17). Psychological status is a research focus as well.…”

Intrathecal Analgesia Via a Percutaneous Port For the Management of Movement-Evoked Breakthrough Cancer Pain of Refractory Lower Extremity Cancer Pain: A Retrospective Review and Commentary

“…High cost limited the use of the implanted intrathecal morphine pump despite it is more suitable for longterm use. Recently, intrathecal morphine infusion therapy via a percutaneous port (IMITPP) has become a popular option for refractory cancer pain in some countries for its relatively lower cost [19]. In the present study, we assessed the e cacy and safety of IMITPP.…”

“…Due to its relatively lower cost, Intrathecal morphine infusion therapy via percutaneous port (IMITPP) may be a better option for cancer patients with a shorter predicted survival than via an implantable morphine pump [18,19]. IMITPP is a percutaneous port attached to an external drug infusion pump that allows for continuous intrathecal analgesia for the management of spontaneous resting pain (SRP), patientcontrolled intrathecal analgesia (PCIA) for the management of movement evoked breakthrough pain (MEBTP) and/or self-titrate to analgesic effect [16,20].…”