| 18F-054 |
Comparison Between Intrathecal and Epidural drug infusion for Refractory Cancer Pain: impact on pain, complication
Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea1
Department of Anesthesia and pain Medicine, Kuala Lumur General Hospital, Kuala Lumpur, Malaysia2
Introduction: Treating intractable cancer pain is challenging. In 1986, the world health organization has come up with a three step ladder to assist clinicians in treating cancer pain. While 90% of cancer patient’s pain and 75% of palliative cancer patient’s pain are treated well with the use of this guideline, substantial number of patients who may need further treatment or interventions. Thus, a fourth step was proposed which included the use of interventions to treat cancer pain. Neuroaxial infusions are part of this intervention group which includes either intrathecal catheter insertion or epidural catheter insertion. In this article, we performed an audit comparing the efficacy and complications of intrathecal and epidural port insertions.
Methods: We studied the data of 48 patients who was either inserted epidural or intrathecal port. Demographic data, type of cancer, NRS scores before insertion, and post insertion at Day 1, Day 3, Day 7 and Day 30 was collected. All patients were given morphine but other factors such as addition of local anesthetics and dexmedetomidine as adjuvants were noted. Lastly, we also collected data for the number of cases which has complications and the type of complications.
Results: 18 patients had epidural port inserted while 30 patients had epidural port inserted. In the epidural group, the gender distribution was uneven with 15 male patients and 3 female patients while the intrathecal group had equal gender distributions at 15 males and 5 females. There were no difference between mean weights for both groups, which was at 55.5kg. The type of overall mean numeric rating scale (NRS) scores were not significantly different between both groups before insertion and post insertion at D1, D3, D7 and D30. While there were 7 patients in the epidural group with complications and 8 from the intrathecal group who developed complications, statistical comparison with the number of complications between groups were not significant (p=0.44). Most complications in the epidural group were urinary retention while in the intrathecal group it was kinking of the catheter. Three patients in the epidural group developed infection while two patient the intrathecal group developed postdural puncture headaches.
Conclusion: In conclusion, both methods are good methods of controlling pain with no differences in NRS scores and they also had no statistical difference in terms of number of complicated cases. However, the types of complications differ between both groups and the cause for this deference should be studied further.
Methods: We studied the data of 48 patients who was either inserted epidural or intrathecal port. Demographic data, type of cancer, NRS scores before insertion, and post insertion at Day 1, Day 3, Day 7 and Day 30 was collected. All patients were given morphine but other factors such as addition of local anesthetics and dexmedetomidine as adjuvants were noted. Lastly, we also collected data for the number of cases which has complications and the type of complications.
Results: 18 patients had epidural port inserted while 30 patients had epidural port inserted. In the epidural group, the gender distribution was uneven with 15 male patients and 3 female patients while the intrathecal group had equal gender distributions at 15 males and 5 females. There were no difference between mean weights for both groups, which was at 55.5kg. The type of overall mean numeric rating scale (NRS) scores were not significantly different between both groups before insertion and post insertion at D1, D3, D7 and D30. While there were 7 patients in the epidural group with complications and 8 from the intrathecal group who developed complications, statistical comparison with the number of complications between groups were not significant (p=0.44). Most complications in the epidural group were urinary retention while in the intrathecal group it was kinking of the catheter. Three patients in the epidural group developed infection while two patient the intrathecal group developed postdural puncture headaches.
Conclusion: In conclusion, both methods are good methods of controlling pain with no differences in NRS scores and they also had no statistical difference in terms of number of complicated cases. However, the types of complications differ between both groups and the cause for this deference should be studied further.
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