-Case Reports-

A Case of Cancer Pain Management by Long-Term Intrathecal PCA

Chiyo Sato, Tadashi Okabe, Kazuhiro Nakanishi and Atsuhiro Sakamoto

Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School

Titration of oral or intravenous medication is the preferred method of pain management for most patients with cancer pain. However, some patients experience insufficient pain relief or considerable adverse effects from systemic opioids. For these reasons, the control of severe cancer pain continues to present a variety of challenges to clinicians. We report our experience of successfully managing cancer pain in a patient by means of long-term intrathecal administration of morphine, bupivacaine, and racemic ketamine via a patient-controlled delivery system. This therapy reduced the patient's nausea, vomiting, and somnolence, led to early hospital discharge, and increased her level of daily activity. There were no signs of motor paralysis, psychomimetic alteration, neurological dysfunction, or infection related to the intrathecal route during treatment. Intrathecal therapy is an effective treatment in terminally ill patients.

J Nippon Med Sch 2010; 77: 333-337

Keywords
intrathecal therapy, cancer pain, patient controlled analgesia, opioid, ketamine

Correspondence to
Chiyo Sato, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
chiyosato@nms.ac.jp

Received, June 18, 2010
Accepted, September 8, 2010