Neuropathologic Findings after Long-term Intrathecal Infusion of Morphine and Bupivacaine for Pain Treatment in Cancer Patients

Sjöberg, Magdalena; Karlsson, Per-Åke; Nordborg, Claes; Wallgren, Arne; Nitescu, Petre; Appelgren, L.; Linder, Lars; Curelaru, I

doi:10.1097/00000542-199202000-00004

Cited by 111 publications

(55 citation statements)

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“…There were no major differences in the doses of morphine and bupivacaine and duration of their administration. As in the current study, Sjöberg et al 2) found nerve damage, however a study by Wagemans et al found no nerve damage 4) . Further study is needed to clarify this discrepancy.…”

Section: Discussionsupporting

confidence: 53%

“…Various neuropathological studies on this method of pain relief have been performed, but most have focused on inflammatory mass formation at the catheter tip, and reports on spinal disorders and nerve damage such as degenerative necrosis and demyelination of spinal nerve cells using human autopsy material are extremely rare [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

“…In 1992, Sjöberg et al 2) neuropathologically studied 15 patients who received long−term administration of morphine and bupivacaine, a local anesthetic; they reported finding damage to the spinal cord and nerve roots. In 1994, Karlsson et al 3) similarly reported damage to the spinal nerves.…”

Section: Introductionmentioning

confidence: 99%

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Neurohistopathological findings after continuous intrathecal administration of opioids and bupivacaine for pain treatment in cancer patients

Kawamura¹,

Fukushige²

2013

Palliat Care Res

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Introduction: Few studies have examined neuropathological changes such as the degenerative necrosis and demyelination of spinal nerve cells accompanying intrathecal administration of opioids (ITO) to relieve refractory cancer pain. Previous studies have produced conflicting results as to whether or not ITO causes nerve tissue damage. The current study neuropathologically investigated autopsy specimens from patients who received ITO. Methods: Subjects were 7 patients who received continuous intrathecal analgesia and who were later autopsied (4 males, 3 females). Six patients were administered morphine and bupivacaine while 1 patient was administered fentanyl and bupivacaine. The duration of administration ranged from 6-345 days. Results: Two patients who received long-term administration of morphine were found to have severe necrotic degeneration and gliosis of spinal neurons and demyelination in the dorsal horn and dorsal roots. However, neuropathological changes were not noted in Patient 4, who was briefly administered morphine, or in the patient who was administered fentanyl. Conclusion: The total dose of morphine used for ITO and the duration of its administration were suggested to be related to the extent of nerve tissue damage. Thus, nerve tissue damage due to ITO might be primarily associated with morphine. Palliat Care Res 2013; 8(2): 192-8

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

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Neurohistopathological findings after continuous intrathecal administration of opioids and bupivacaine for pain treatment in cancer patients

Kawamura¹,

Fukushige²

2013

Palliat Care Res

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“…Fibrosis may occur around the catheter after long-term epidural morphine administration, resulting in encapsulation with consequent pain at the injection still and loss of efficacy. On the other hand, cases of any reaction against the nylon catheter within its subarachnoid space were recorded [56].…”

Section: Epidural Administrationmentioning

confidence: 99%

Controversies over spinal treatment in advanced cancer patients

Mercadante¹

1998

Supportive Care in Cancer

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About 10% of patients with cancer pain do not obtain pain relief or experience unacceptable side effects with systemic opioids. In some cases a change of the route of administration can improve the balance of analgesia and adverse effects. In this paper the use of spinal opioids in such patients is discussed from various aspects: patient selection, epidural vs intrathecal administration, dosage, association with local anaesthetic agents, dosage conversion systems (for the change from systemic administration) and home use. The main problems involved are dealt with an attempt to find how to use the drugs and techniques involved to the best possible advantage.

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“…These results led Crul and Delhaas [14•] to recommend that the epidural route of administration only be used in patients with a life expectancy of less than 1 month. On postmortem examination of patients who had been treated with epidural infusion for an average of 2.5 months, Sjöberg et al [15] found an extradural fibrin coating that frequently surrounded the catheter. This tissue reaction, however, was not routinely observed in the intrathecal space [15,16].…”

mentioning

confidence: 99%

Subarachnoid techniques for cancer pain therapy: When, why, and how?

Buchheit

Rauck

1999

Current Review of Pain

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For cancer patients who obtain inadequate pain relief with conservative treatment, there is a growing list of effective options for subarachnoid therapy. Morphine and bupivacaine have been the most frequently used drugs for intrathecal infusion, and their use has consistently yielded good results. Despite their effectiveness, however, a therapeutic deficit remains, primarily in the treatment of neuropathic cancer pain. Because of this limitation, more recent research has focused on novel compounds for intrathecal therapy such as clonidine, midazolam, ketamine, and SNX-111. In addition to new drug options, there are various catheter delivery systems from which to choose. In reviewing the literature and experience to date with these various medications and delivery systems, we hope to better aid the clinician in tailoring the best treatment for each patient.

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Neuropathologic Findings after Long-term Intrathecal Infusion of Morphine and Bupivacaine for Pain Treatment in Cancer Patients

Cited by 111 publications

References 0 publications

Neurohistopathological findings after continuous intrathecal administration of opioids and bupivacaine for pain treatment in cancer patients

Neurohistopathological findings after continuous intrathecal administration of opioids and bupivacaine for pain treatment in cancer patients

Controversies over spinal treatment in advanced cancer patients

Subarachnoid techniques for cancer pain therapy: When, why, and how?

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