[Long-term intraspinal narcotics administration by means of an implantable fluid delivery system in the treatment of cancer pain].
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We resuscitated unanesthetized bled sheep (bled volume = 1.2-1.7 liters) with 200 ml of hypertonic saline/dextran 70 infused either through a peripheral vein (n = 6) or directly into the red marrow of the sternum (n = 6). Intraosseous infusion of the viscous 7.5% NaCl/6% dextran solution required 2-4 min. Plasma sodium was rapidly increased to the same level in both groups demonstrating equally rapid entry into the vascular space. Both regimens provide rapid and sustained normalization of arterial pressure and cardiac output. No significant differences between the two groups were apparent for any measured variable. Intraosseous infusion of hypertonic resuscitation fluids merits further research to evaluate the safety and efficacy for prehospital treatment of hypovolemia and trauma.
46 MS-patients were treated by systemic or intrathecal administration of steroids. Before and three weeks after the beginning of the treatment, we measured the latencies of visual and somatosensory evoked potentials and examined clinically according to the Expanded Disability Status Scale (EDSS). Only one patient showed significant changes in VEP latencies, SEP showed equivalent results before and after therapy. In contrast, in 24 out of 46 patients the clinical examination revealed a change in EDSS. As a consequence visual and somatosensory evoked potentials can not be regarded as adequate tools for short-term assessment in therapeutic trials.
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Postoperative analgesia using continuous epidural morphine or a single intrathecal injection of morphine has been compared with standard patient-controlled analgesia (PCA) in lumbar fusion patients. Pain relief with epidural morphine was dramatic in some cases (3/12) but was not predictable, and catheter displacement was a frequent occurrence. A single intrathecal bolus of morphine had no advantage over PCA alone. Complications of both intraspinal techniques included nausea and pruritus. No respiratory depression was observed.
Terminal cancer patients report substantial pain frequently. Pain control can be achieved in many patients with conventional methods and analgesics. However, significant numbers of patients remain in pain. For these patients, continuous intrathecal narcotics delivered by an external portable pump via a subcutaneous port, offer substantially improved pain control with minimal risk of serious systemic complications. Duration of treatment in our 40 cancer patients lasted up to 11 month. Continuous intrathecal morphine or fentanyl relieved pain till death due to cancer. Supraspinal side effects of opioids were only seen during the first week of intrathecal narcotic treatment. No serious complications like meningitis or other infections were observed. Postmortem examination also could not detect changes of the cord or signs of arachnoiditis due to intrathecal narcotics or the implanted catheter. We conclude, that continuous intrathecal narcotic infusion by means of small portable pump is a very efficient method to control terminal cancer pain and enables treatment on an outpatient basis until death.
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Thyrotropin releasing hormone (TRH) has potential therapeutic applications in amyotrophic lateral sclerosis (ALS) and related diseases because of its function as a neuroregulator of the anterior horn cell. However, its therapeutic potential, and that of other neuropeptides, is reduced by the blood-brain barrier that limits access to neuronal cells. We have thus explored the direct intrathecal administration of TRH in ALS, with both short-term boluses and infusions and chronic constant infusions. Our experience suggests that this approach is safe, has high patient acceptance, and is worthy of more careful evaluation.
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The use of intrathecal clonidine, in combination with intrathecal morphine, for the treatment of a patient with intractable cancer pain is reported. The addition of clonidine overcame the problem of tolerance to the analgesic effects of morphine alone. The patient was maintained pain free for three months, without complications, until his death. At autopsy, no evidence of neurotoxicity associated with the prolonged intrathecal administration of clonidine and morphine was found.
Systemic fungal infection in an infant is difficult to diagnose and manage. The treatment is prolonged and is usually with toxic drugs. The use of intravenous and intrathecal miconazole (Daktarin; Janssen) in a small baby of 5 months was most satisfactory.
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At Howard University Hospital, nine terminally ill cancer patients with chronic pain have been treated with continuous intrathecal infusion of morphine delivered by the implantable Infusaid pump. The case of a patient treated at Howard University Hospital with this method of pain management is presented. Following Infusaid pump insertion, the patient lived for 22 months and obtained substantial relief of his cancer pain with no adverse side effects.
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