Morphine péridurale dans les douleurs cancéreuses rebelles. Moyens et obstacles [Peridural morphine in intractable cancer pains. Means and obstacles]

Details

Serval ID
serval:BIB_E1AC23B95FA8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Morphine péridurale dans les douleurs cancéreuses rebelles. Moyens et obstacles [Peridural morphine in intractable cancer pains. Means and obstacles]
Journal
Annales Françaises d'Anesthésie et de Réanimation
Author(s)
Bayer-Berger M.M., Arnér S.
ISSN
0750-7658
Publication state
Published
Issued date
1985
Peer-reviewed
Oui
Volume
4
Number
4
Pages
343-350
Language
french
Abstract
Long-term analgesia with epidural morphine (EM) is a new tool in the management of intractable cancer pain. Twenty-six out of 160 cancer patients referred to the Pain Division for pain assessment were selected for analgesia with long-term epidural morphine, so aiming to define its place amongst more traditional methods of treatment, such as drugs, nerve-blocks, neurosurgery or radiotherapy. All 26 patients were cases of conventional analgesic failure, with very advanced cancer states. Thirteen patients became absolutely pain free throughout the treatment period: five of them were even allowed home. Another ten patients were satisfied with EM, though some residual pain of neurogenic and visceral type persisted. In three patients, epidural morphine was judged as a complete failure. The 134 other patients could be managed with either of the other above mentioned techniques. The most important selection criterion for patients requiring epidural morphine seemed to be continuous multiple site bilateral pain of deep somatic origin. The response was variable in continuous visceral pain, while neurogenic, cutaneous and intermittent pain due to intestinal obstruction responded only exceptionally. EM was most valuable in terminal situations when systemic opiates failed to give satisfactory analgesia, or in acute transitory situations, while waiting for a response to cancer-orientated therapy. Epidural morphine considerably improved the patients' quality of life, compared with conventional methods tried beforehand. Analgesic methods in cancer are palliative procedures. In terminal or temporary situations, other more invasive methods are not suited. The EM technique is simple, adjustable to advancing pain and has few side-effects, especially when compared with neurolytic and neurosurgical procedures.
Keywords
Adult, Aged, Catheters, Indwelling, Epidural Space, Female, Gastrointestinal Motility, Humans, Injections, Male, Middle Aged, Morphine/administration & dosage, Morphine/adverse effects, Neoplasms/physiopathology, Pain, Intractable/drug therapy, Quality of Life, Time Factors
Pubmed
Create date
21/01/2008 18:30
Last modification date
20/08/2019 17:05
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