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Nassif YJ, Zanin ME, Martinez-Sobalvarro JV, de Barros CM, Pacheco-Neto M, Dos Reis TM, Cardoso-Podestá MHM, Torres LH. Effectiveness of epidural morphine for the treatment of cancer pain in patients with gastrointestinal neoplasm-a systematic review. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3819-3827. [PMID: 38180558 DOI: 10.1007/s00210-023-02925-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.
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Affiliation(s)
- Yasmim Jianjulio Nassif
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
| | - Maria Elisa Zanin
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
| | - Joselin Valeska Martinez-Sobalvarro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
- Department of Pharmacy, Health Sciences Sector, Federal University of Paraná, Curitiba, Brazil
| | - Carlos Marcelo de Barros
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
- Department of Anesthesiology, Pain and Palliative Care, Santa Casa of Alfenas, Alfenas, Brazil
| | | | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Márcia Helena Miranda Cardoso-Podestá
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil.
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Hsieh YL, Chen HY, Lin CR, Wang CF. Efficacy of epidural analgesia for intractable cancer pain: A systematic review. Pain Pract 2023; 23:956-969. [PMID: 37455298 DOI: 10.1111/papr.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Epidural analgesia is a common technique for managing perioperative and obstetric pain. Patients with cancer who cannot tolerate opioids or not responding to conventional treatment may benefit from epidural analgesia. Therefore, this systematic review aimed to analyze the efficacy and safety of epidural analgesia in patients with intractable cancer pain. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on patients with cancer who received epidural analgesia. We assessed the quality of all included studies using the risk-of-bias tool or Newcastle-Ottawa scale. The primary outcome was pain relief after epidural analgesia, and the secondary outcome was quality of life, analgesic consumption, and adverse events. The studies were grouped based on the medications used for epidural analgesia. A descriptive synthesis was performed following the Synthesis Without Meta-analysis reporting guideline. RESULTS Our systematic review included nine randomized controlled trials (n = 340) and 15 observational studies (n = 926). Two randomized controlled trials suggested that epidural opioids were not superior to systemic opioids in relieving pain. Epidural opioids combined with local anesthetics or adjuvants, including calcitonin, clonidine, ketamine, neostigmine, methadone, and dexamethasone, offered better analgesic effects. No significant difference in pain relief between an intermittent bolus and a continuous infusion of epidural morphine was observed. Epidural opioids had more analgesic effects on nociceptive pain than neuropathic pain. The methods used to evaluate the quality of life and the corresponding results were heterogeneous among studies. Six observational studies demonstrated that some patients could have decreased opioid consumption after epidural analgesia. Adverse events, including complications and drug-related side effects, were reported in 23 studies. Five serious complications, such as epidural abscess and hematoma, required surgical management. The heterogeneity and methodological limitations of the studies hindered meta-analysis and evidence-level determination. CONCLUSION Coadministration of epidural opioids, local anesthetics, and adjuvants may provide better pain relief for intractable cancer pain. However, we must assess the patients to ensure that the benefits outweigh the risks before epidural analgesia. Therefore, further high-quality studies are required.
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Affiliation(s)
- Yu-Lien Hsieh
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Yu Chen
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ren Lin
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Fei Wang
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nursey F, Gillett K. Intrathecal drug delivery for cancer pain at the end of life: a case study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S16-S22. [PMID: 36913330 DOI: 10.12968/bjon.2023.32.5.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Two-thirds of patients with advanced cancer have pain and, of these, approximately 10-20% do not respond to conventional pain management approaches. This case study concerns a hospice patient who received intrathecal drug delivery for intractable cancer pain at the end of life. This involved working in partnership with a hospital-based interventional pain team. Despite side-effects and complications associated with intrathecal drug delivery and the requirement for inpatient nursing care, intrathecal drug delivery was the best option for the patient. The case identifies the importance of a patient-centred approach to decision-making, effective partnerships between hospice and acute hospital teams, and nurse education as key factors contributing to the provision of safe and effective intrathecal drug delivery.
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Yaghi M, Beydoun N, Mowery K, Abadir S, Bou Zerdan M, Jabbal IS, Rivera C, Liang H, Alley E, Saravia D, Arteta-Bulos R. Social disparities in pain management provision in stage IV lung cancer: A national registry analysis. Medicine (Baltimore) 2023; 102:e32888. [PMID: 36827013 DOI: 10.1097/md.0000000000032888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
A strong association exists between pain and lung cancer (LC). Focusing on the disparities in pain referral in LC patients, we are aiming to characterize the prevalence and patterns of referrals to pain management (PM) in Stage IV non-small-cell LC (NSLC) and small-cell LC (SCLC). We sampled the National Cancer Database for de novo stage IV LC (2004-2016). We analyzed trends of pain referral using the Cochran-Armitage test. Chi-squared statistics were used to identify the sociodemographic and clinico-pathologic determinants of referral to PM, and significant variables (P < .05) were included in one multivariable regression model predicting the likelihood of pain referral. A total N = 17,620 (3.1%) of NSLC and N = 4305 (2.9%) SCLC patients were referred to PM. A significant increase in referrals was observed between 2004 and 2016 (NSLC: 1.7%-4.1%, P < .001; SCLC: 1.6%-4.2%, P < .001). Patient and disease factors played a significant role in likelihood of referral in both groups. Demographic factors such as gender, age, and facility type played a role in the likelihood of pain referrals, highlighting the gap and need for multidisciplinary PM in patients with LC. Despite an increase in the proportion of referrals to PM issued for terminal stage LC, the overall proportion remains low. To ensure better of quality of life for patients, oncologists need to be made aware of existent disparities and implicit biases.
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Affiliation(s)
- Marita Yaghi
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Najla Beydoun
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Kelsey Mowery
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | | | - Maroun Bou Zerdan
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Iktej Singh Jabbal
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Carlos Rivera
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Hong Liang
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Evan Alley
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Diana Saravia
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Rafael Arteta-Bulos
- Department of Hematology/Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
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Ma X, Gao Y, Wang J, Wu Z, Shen H, Wang P. Efficacy of Transversus Abdominis Plane Block in Patients After Laparoscopic Radical Cervical Cancer Surgery. Front Surg 2022; 9:674987. [PMID: 35433817 PMCID: PMC9010526 DOI: 10.3389/fsurg.2022.674987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to evaluate the efficacy of transversus abdominis plane block (TAPB) in patients after laparoscopic radical cervical cancer surgery. Methods A total of 120 patients with cervical cancer who underwent laparoscopic radical resection in the hospital from January 2019 to January 2020 were selected and concurrently assigned to either patient-controlled intravenous analgesia (PCIA) (Control group) or PCIA plus TAPB (Observation group) according to different methods. The visual analogscale (VAS), Bruggemann comfort scale (BCS), immune function indicators, hemodynamics, analgesia indicators, and postoperative recovery time were recorded and compared. Results The Observation group had a lower VAS score and a higher BCS postoperatively compared with the Control group, and the difference was statistically significant. After the operation, immune function indexes of patients in the two groups were declined, and the difference was statistically significant. At 76 h after operation, the immune function indexes of the Control group were lower than the Observation group, and the difference was statistically significant. After the operation, the Control group obtained a higher mean arterial pressure (MAP) at extubation, and the difference was statistically significant. The Observation group outperformed the Control group in terms of analgesia indicators and postoperative recovery time, and the difference was statistically significant. Conclusion TAPB can enhance the analgesic effect of patients after laparoscopic radical resection of cervical cancer, stabilize their physical signs, has little effect on the patient's immune function, with a high safety profile.
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Affiliation(s)
- Xiaoyu Ma
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Yi Gao
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jing Wang
- Department of Anesthesiology, Central Hospital of Jiaozuo Coal Industry Group, Jiaozuo, China
| | - Zhen Wu
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huasu Shen
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Ping Wang
- Department of Anesthesiology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
- *Correspondence: Ping Wang
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