[Ambulatory epidural analgesia in patients with tumors. An outmoded technique?]

In 35 of 316 patients suffering from severe cancer pain, an epidural catheter was placed for continuous morphine application. Indications for epidural opiates included failure of pain relief with oral morphine, severe side effects with oral administration, and contraindications for oral morphine, e.g., ileus. METHODS. The epidural catheter was inserted in the lumbar, thoracic or cervical region, according to the main localization of pain. A silicon catheter with a Dacron cuff (4.2 F Broviac Davol, Cranston, R.I.) was connected and tunneled subcutaneously to a distant exit on the lateral chest wall (Fig. 2). A portable morphine pump (CADD-PCA Pharmacia Deltec) was connected to the externalized catheter. The morphine was infused continuously at a basic rate. It could be increased to a programmed limit by additional boli determined by the patients themselves. Thirty patients were treated as outpatients. RESULTS. The mean duration of treatment was 101 (10-333) days. The daily dose of morphine ranged from 9 to 200 (33) mg at the beginning of therapy, and from 20 to 288 (88) mg at the end of treatment. In 27 patients (77%) epidural morphine administration proved to be a valuable method of pain control (Fig. 3). Even in most cases of tolerance to oral morphine, especially in patients suffering from pain of neuropathic origin, pain control was adequate. There were no cases of continuous loss of effectiveness of continuous loss of effectiveness or development of tolerance (Fig. 5). The epidural morphine dosage depended on the character and intensity of pain and its responsiveness to epidural opiates. Technical complications were noticed in 6 patients (17%), and fairly mild side effects of epidural morphine occurred in 20% of the patients for a limited time. CONCLUSIONS. The technique described is a simple and convenient method for long-term treatment of cancer patients with epidural morphine. There was no need for more invasive procedures, such as intrathecal or intraventricular morphine administration, in this group of patients in whom no pain relief had been achieved with oral morphine administration.