Pain treatment on outpatient basis utilizing extradural opiates. A danish multicentre study comprising 105 patients

Abstract

Eight major Danish anesthesiological departments registered 105 patients treated with extradural opiates for a period of > 7 days, partially or completely on outpatient basis. Ninety-four suffered from painful malignant diseases and 11 patients from various painful benign diseases. The mean period of treatment was 65 days (range: 7-283 days) and of these 49 days (2-266 days) as outpatients. The total number of inserted epidural catheters was 215, with an average of 2/patient (range 1-5). Reasons for removing an extradural catheter were injection-related pain, difficulty in injecting the desired volume and displacement of catheter. Morphine chloride, in a solution of 0.4 mg/ml of normal saline, was the main choice as analgesic agent (90 patients). The mean daily dose of this drug totaled 12.6 .+-. 4.8 mg SD (range: 4-30 mg) distributed as 2.7 .+-. 0.9 SD (range: 1-6) daily injections. Twelve patients were treated with buprenorphine extradurally. Satisfactory pain relief was achieved for 70 patients (67%) who managed with extradural opiates as sole analgesic treatment. One patient developed septicemia with a nonfatal outcome probably originating from some other focus. Apart from this no serious effects were reported. Medically unskilled persons or relatives were responsible for instillation of all extradural opiates with 42 patients and partially responsible with 14 patients. Eleven patients managed injections without assistance. District nurses took care of medication for 46 patients, aided by a general practitioner in 5 cases. Three patients were supplied with continuous extradural infusion by means of a Mill Hill microinfusion pump.