Subarachnoid buprenorphine administered by implantable micropumps

Abstract

This report concerns 23 patients, the majority of whom are suffering from low back and chest pain caused by chest, urological or gynaecological cancer. These patients were treated with subarachnoid buprenorphine, administered in a single bolus or by slow infusion from micropumps, at a daily dose adapted to patients need (0.06-0.15 mg). The painful symptomatology was successfully controlled in all the cases treated, allowing the patients to live a virtually normal life. In no cases was respiratory depression or tolerance observed.

Spinal opioids in adult patients with cancer pain: A systematic review: A European Palliative Care Research Collaborative (EPCRC) Opioid Guidelines Project

“…Cases series also had small samples sizes, which were less than 20 patients in three studies. 50 – 52 The epidural route was used in one study 51 and the intrathecal in four studies 50,52 – 54 . The addition of bupivacaine to spinal opioids was described in one study, 51 and the use of implantable systems was described in four studies.…”

“…The addition of bupivacaine to spinal opioids was described in one study, 51 and the use of implantable systems was described in four studies. 50,52 – 54 Pain relief was classified by word categories in three studies 50,52,53 and percentage of relief and use of analgesics in one study. 54 The use of adjuvant analgesics by other routes was described in four studies 50,51,53,54 and side effects after spinal opioid treatment also in four studies.…”

Rational Use of Sublingual Opioids in Palliative Medicine

“…41 It has subsequently been used by a variety of other routes including epidural, [42][43][44] subarachnoid, 45 subcutaneous, 46 intravenous, 47 intramuscular, 48,49 transdermal, [50][51][52][53][54][55][56] The use of buprenorphine for cancer pain has recently been reviewed. 57 Buprenorphine in cancer pain-chiefly as a new, transdermal formulation available in Europe and Australia-is acquiring a rapidly expanding evidence base of safety and efficacy.…”

Buprenorphine in cancer pain

“…Administration by rectum or by nebulization has not been described. Both epidural and subarachnoid buprenorphine have been used to treat cancer pain [71][72][73]. However, the physicochemical characteristics of buprenorphine, like fentanyl, are such that there is rapid systemic absorption, and thus, buprenorphine is not regionally confined.…”

“…Doses ranged between 0.06 and 0.15 mg daily, with a good response in all. No respiratory depression or analgesic tolerance was noted [72].…”