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Chronic epidural bupivacaine-opioid infusion in intractable cancer pain.

Publication ,  Journal Article
Du Pen, SL; Kharasch, ED; Williams, A; Peterson, DG; Sloan, DC; Hasche-Klunder, H; Krembs, AW
Published in: Pain
June 1992

This study examined the efficacy and toxicity associated with chronic epidural opioid-bupivacaine infusions. In a series of 68 patients with cancer pain refractory to epidural opioids alone, analgesia was effectively regained by infusing a opioid-bupivacaine combination. Sixty-one patients (90%) were considered treatment successes, according to conventional criteria. Median length of therapy was 60-120 days, with the longest infusion lasting 277 days. Chronic bupivacaine infusion concentrations ranged from 0.1 to 0.5% with infusion rates varying from 4 to 18 ml/h. The majority of patients experienced pain relief with little or no sympathetic or sensorimotor impairment after the first 24 h at bupivacaine concentrations of 0.125-0.25% and were managed in home or chronic care settings without the need for re-hospitalization. In patients receiving higher bupivacaine concentrations, sympathetic, sensory and motor blockade were well tolerated during chronic infusion. Sensory loss was consistently observed only at bupivacaine concentrations exceeding 0.25%, and motor impairment occurred only at concentrations exceeding 0.35%. Postural hypotension was observed in 6 patients (9%) for the first 24 h only, which supports the requirement for monitoring and fluid therapy during initiation of the bupivacaine infusion. No patient experienced CNS or systemic toxicity, despite plasma total bupivacaine concentrations as high as 10.8 micrograms/ml. Serial plasma bupivacaine levels were measured in 15 patients during chronic infusion. There was considerable inter- and intra-individual variability in plasma bupivacaine concentrations and bupivacaine clearance. We conclude that epidural opioid-bupivacaine infusion is an effective and safe technique for long-term administration of analgesics in the refractory cancer patient.

Duke Scholars

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Published In

Pain

DOI

ISSN

0304-3959

Publication Date

June 1992

Volume

49

Issue

3

Start / End Page

293 / 300

Location

United States

Related Subject Headings

  • Pain, Intractable
  • Neoplasms
  • Narcotics
  • Humans
  • Drug Therapy, Combination
  • Bupivacaine
  • Blood Pressure
  • Anesthesiology
  • Analgesia, Epidural
  • 52 Psychology
 

Citation

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Du Pen, S. L., Kharasch, E. D., Williams, A., Peterson, D. G., Sloan, D. C., Hasche-Klunder, H., & Krembs, A. W. (1992). Chronic epidural bupivacaine-opioid infusion in intractable cancer pain. Pain, 49(3), 293–300. https://doi.org/10.1016/0304-3959(92)90234-3
Du Pen, Stuart L., Evan D. Kharasch, Anna Williams, Donald G. Peterson, Dean C. Sloan, Hans Hasche-Klunder, and Alexander W. Krembs. “Chronic epidural bupivacaine-opioid infusion in intractable cancer pain.Pain 49, no. 3 (June 1992): 293–300. https://doi.org/10.1016/0304-3959(92)90234-3.
Du Pen SL, Kharasch ED, Williams A, Peterson DG, Sloan DC, Hasche-Klunder H, et al. Chronic epidural bupivacaine-opioid infusion in intractable cancer pain. Pain. 1992 Jun;49(3):293–300.
Du Pen, Stuart L., et al. “Chronic epidural bupivacaine-opioid infusion in intractable cancer pain.Pain, vol. 49, no. 3, June 1992, pp. 293–300. Pubmed, doi:10.1016/0304-3959(92)90234-3.
Du Pen SL, Kharasch ED, Williams A, Peterson DG, Sloan DC, Hasche-Klunder H, Krembs AW. Chronic epidural bupivacaine-opioid infusion in intractable cancer pain. Pain. 1992 Jun;49(3):293–300.
Journal cover image

Published In

Pain

DOI

ISSN

0304-3959

Publication Date

June 1992

Volume

49

Issue

3

Start / End Page

293 / 300

Location

United States

Related Subject Headings

  • Pain, Intractable
  • Neoplasms
  • Narcotics
  • Humans
  • Drug Therapy, Combination
  • Bupivacaine
  • Blood Pressure
  • Anesthesiology
  • Analgesia, Epidural
  • 52 Psychology