Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study
Authors' conclusion
Placing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events.
Study context
- Population
- Patients with primary or metastatic craniofacial cancer pain, eleven medical centers, September 2019 to December 2023
- Participants
- 33 patients · 11 centres
- Exposure
- Postimplant vs preoperative
- Prepontine cistern intrathecal morphine pumpn = 33
- Outcome
- NRS pain score
- Follow-up
- Postimplant days 1, 7, 30 vs before surgery
Methodological detailsmulticentre, single-group
- Multicentre
- Single-group
Main finding
As reported in the abstract
- Numeric rating scale (NRS) before surgery, median (IQR)
- 8.0 (7.0-10.0)
- NRS day 1 postimplant, median (IQR)
- 2.0 (1.0-3.5)
- NRS day 7 postimplant, median (IQR)
- 2.0 (1.0-2.0)
- NRS day 30 postimplant, median (IQR)
- 1.0 (1.0-2.0)
- Each postimplant time point vs before surgery
- all P < .001
Observational data: associations, not effects.
Further findings
Breakthrough pain episodes (number/d) · Postimplant days 1, 7, 30 vs baseline
- Baseline, median (IQR)
- 6.0 (4.5-10.0)
- Day 1, median (IQR)
- 1.0 (0.0-3.0)
- Day 7, median (IQR)
- 2.0 (0.0-3.0)
- Day 30, median (IQR)
- 0.0 (0.0-1.2)
- Each vs baseline
- all P < .001
Pain relief >50% · Postimplant days 1 and 30
- Day 1
- 78.8%
- Day 30
- 96.7%
- Proportion with pain relief >75% increased from day 1 to day 30
Systemic morphine equivalents dose (mg.d −1) · Postimplant days 1, 7, 30 vs baseline
- Baseline, median (IQR)
- 228 (120-408)
- Day 1, median (IQR)
- 0 (0-120)
- Day 1 vs baseline
- P = 0.001
- Days 7 and 30, median (IQR)
- 0 (0-0)
- Days 7 and 30 vs baseline
- both P < .001
Safety
Perioperative adverse events
- Severe adverse events
- 0
- Few patients reported nausea, constipation, hypotension, urinary retention, dry mouth, headache, sedation
Original publication
Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study. Anesth Analg. Published 11 September 2024. doi:10.
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