Outcome and complications of epidural analgesia in patients with chronic cancer pain

Smitt, Peter Sillevis; Tsafka, Anna; Zande, Frederique Teng-van de; Holt, Bronno van der; Vries, Ineke Elswijk‐de; Elfrink, E.J.; Bent, Martin J. van den; Vecht, Charles J.

doi:10.1002/(sici)1097-0142(19981101)83:9<2015::aid-cncr19>3.0.co;2-r

Cited by 89 publications

(52 citation statements)

References 33 publications

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“…Smitt et al (22) , em estudo com pacientes oncológicos, concluíram que a infecção peridural é freqüente e que, na presença de qualquer sintoma, como dor nas costas persistente, febre ou déficit neurológico deve ser prontamente avaliado por ressonância magnética.…”

Section: Discussionunclassified

Incidência de infecção em pacientes com cateter peridural tunelizado

2005

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O cateter peridural tunelizado como via de administração de opiáceos vem sendo utilizado desde o início de 1980. Pacientes com dor crônica, que não obtêm alívio com medicamentos por outras vias, são muito beneficiados com infusão de opiáceo associado a um anestésico local por via peridural. Entretanto, ainda existem dúvidas sobre a eficácia do método, no manuseio e, conseqüentemente, quanto ao risco de infecção e outras complicações. Sendo a equipe de enfermagem fundamental para efetivar o tratamento para o alívio da dor, esse estudo propõe demonstrar como manter a técnica segura. Foram acompanhados 27 pacientes com dor crônica entre 2002 e 2004, que utilizaram o cateter peridural por 18 dias em média, implantados em nível torácico ou lombar. Não houve complicações como abcesso peridural, meningite ou hematoma peridural. A satisfação dos pacientes quanto a analgesia foi evidente.

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Section: Discussionunclassified

Incidência de infecção em pacientes com cateter peridural tunelizado

2005

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“…Although adequate analgesia was obtained in all 16, complications occurred in 11 of the 16 patients, including dislodged or broken catheters, pain on injection, bleeding, bruising, or infection. Epidural analgesia gave adequate pain relief in 76% of 91 patients who received it, but complications occurred in 43%, such that the authors did not recommend this intervention for patients with more than 3 months to live [28]. Other experts in the field have reported excellent success with externalized intrathecal catheters, which are not more complicated to administer than epidurals, with 93% perfect function in 200 patients [29].…”

Section: Intraspinal Versus Epidural Therapymentioning

confidence: 99%

Pain management, including intrathecal pumps

Smith

Swainey

Coyne

2005

Current Science Inc

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Even when managed according to guidelines, approximately 14% of cancer patients have unrelieved pain or unacceptable side effects, and there is good evidence that patients still are not receiving optimal therapy. Implantable drug delivery systems (IDDS) administer small amounts of drugs directly to the spinal cord and reduce systemic narcotic exposure by a factor of 300 to one. In a large randomized trial of 202 patients with pain scores of 7.5 or higher, despite 200 mg or more of morphine or equivalent narcotics, IDDS gave better clinical success than comprehensive medical management (84.5% vs 70.8%, P=0.05). Pain scores were reduced by 52% versus 39%, drug toxicity scores were reduced by 50% versus 17%, and IDDS patients lived longer. Even the most refractory pain patients--those failed by a month of comprehensive medical management by experts--when subsequently provided with IDDS, had a 27% reduction in pain scores and a 50% reduction in drug side effects. Given multiple positive small cohort studies and a positive high-power randomized trial, IDDS should be considered as the best treatment for this population.

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“…A total of 137 epidural catheters were placed in 91 patients, with a total of 4326 catheter days [27]; median survival from the time of first catheter placement was 38 days. All patients received a mixture of morphine or sufentanil and bupivacaine.…”

Section: Patientsmentioning

confidence: 99%

Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging

Smitt¹,

Tsafka²,

Bent³

et al. 1999

Journal of Neurology

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We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). Patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. Magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed Staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.

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Outcome and complications of epidural analgesia in patients with chronic cancer pain

Cited by 89 publications

References 33 publications

Incidência de infecção em pacientes com cateter peridural tunelizado

Incidência de infecção em pacientes com cateter peridural tunelizado

Pain management, including intrathecal pumps

Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging

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