Intrathecal pain pump infusions for intractable cancer pain: An algorithm for dosing without a neuraxial trial Journal Article

   

Authors:	Malhotra, V. T.; Root, J.; Kesselbrenner, J.; Njoku, I.; Cubert, K.; Gulati, A.; Puttanniah, V.; Bilsky, M.; Kaplitt, M.
Article Title:	Intrathecal pain pump infusions for intractable cancer pain: An algorithm for dosing without a neuraxial trial
Abstract:	Background: Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. Methods: We used data pre- and postpump from 46 cancer patients receiving systemic opioids undergoing intrathecal pump placement in the last 6 years, all of whom had undergone an epidural trial before pump placement. RESULTS: By analyzing intrathecal opioid dosage on discharge (in IV morphine equivalents) to age, type of pain, cancer type, preimplant opioid dose, and preimplant pain score using multiple regression, we created an algorithm that predicts, for cancer patients, an appropriate initial dose for an intrathecal pump based on the prepump systemic opioid dose, thus avoiding an epidural trial. The predicted value does have a broad 95% prediction interval (-122.7% to 147.6%) pointing to the value of a trial when feasible. CONCLUSIONS: When an epidural trial is not feasible and an intrathecal pump is required in a cancer patient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home. © 2013 International Anesthesia Research Society.
Keywords:	adult; clinical article; controlled study; cancer patient; opiate; cancer pain; hospitalization; algorithm; scoring system; hospital discharge; methadone; morphine; bupivacaine; hydromorphone; patient controlled analgesia; fentanyl; intractable pain; clonidine; intrathecal pump
Journal Title:	Anesthesia and Analgesia
Volume:	116
Issue:	6
ISSN:	0003-2999
Publisher:	Lippincott Williams & Wilkins
Date Published:	2013-06-01
Start Page:	1364
End Page:	1370
Language:	English
DOI:	10.1213/ANE.0b013e31828d670e
PROVIDER:	scopus
PUBMED:	23558833
PMCID:	PMC5529040
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84878391147&partnerID=40&md5=c8ff84af86662b018a36654ab67dc9c2
Notes:	--- - "Export Date: 1 July 2013" - "CODEN: AACRA" - "Source: Scopus"

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