For patients with uncontrolled pain from terminal cancer, a new approach to calculating initial dosage may allow a quicker start of spinal analgesia—and less time in the hospital, according to a study in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).
Led by Dr Vivek Tim Malhotra of Memorial Sloan Kettering Cancer Center, New York, the researchers developed a set of equations for estimating the initial dose of intrathecal spinal pain relievers, thus avoiding the need for a trial period of epidural anesthesia in the hospital. The researchers hope their method will shorten the time to satisfactory pain control in patients with pain from advanced cancer, allowing them to spend more of their remaining days at home.
New Equations for Estimating Intrathecal Analgesia Dose
Intrathecal analgesia is an important option for "intractable" cancer pain that no longer responds to oral or injected pain medications. In this technique, a catheter is placed in the intrathecal space around the spinal cord, with individualized doses of strong opioid pain relievers given through a drug pump. The standard approach to determining the initial dose is a trial period of another type of spinal drug injection—epidural analgesia—performed in the hospital.
However, by the time patients are referred to a pain specialist for spinal analgesia, they typically have advanced cancer with limited life expectancy. Dr Malhotra and colleagues were looking for some way of calculating the initial intrathecal analgesia dose without the need for an epidural trial.
The researchers performed an in-depth analysis of 46 patients, treated over a six-year period, who underwent an epidural drug trial before intrathecal analgesia. The goal was to develop a way of predicting the initial intrathecal dose based on the patient's last oral or injected ("systemic") drug dosage.
Based on this and other factors—including the patient's age, type of pain, type of cancer, and pain severity score—the researchers were able to develop relatively simple equations for predicting the initial intrathecal opioid dose needed to control the patients' pain. The equations provided at least a guideline for estimating the initial spinal analgesia dose, while avoiding the need for an epidural trial.
In the 46 patients studied, time spent in the hospital for placement of the spinal catheter and epidural trial was between 9 and 17 days. Dr Malhotra and coauthors estimated that using the study equations—and avoiding the need for an epidural trial—could reduce hospital days by about half.
"This reduces time in the hospital for those with an already limited life expectancy and minimizes medical cost and potential complications," Dr Malhotra and coauthors write. For the patients studied, median life expectancy after leaving the hospital was less than three months.
The researchers note that their equations had a wide statistical range, indicating that they are best used for patients expected to survive only a short time. But for these patients, the study equation will provide a useful starting point, allowing patients to spend more of their final days at home rather than in the hospital. Dr Mahtola and colleagues plan further research—including data on side effects and quality of life—to refine their equations and better evaluate the benefits of intrathecal analgesia for intractable cancer pain.
Read the article in Anesthesia & Analgesia
About the IARS
The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; and publishes the monthly journal Anesthesia & Analgesia in print and online.
About Anesthesia & Analgesia
Anesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.
Nancy Lynly | EurekAlert!
Hot cars can hit deadly temperatures in as little as one hour
24.05.2018 | Arizona State University
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
The more electronics steer, accelerate and brake cars, the more important it is to protect them against cyber-attacks. That is why 15 partners from industry and academia will work together over the next three years on new approaches to IT security in self-driving cars. The joint project goes by the name Security For Connected, Autonomous Cars (SecForCARs) and has funding of €7.2 million from the German Federal Ministry of Education and Research. Infineon is leading the project.
Vehicles already offer diverse communication interfaces and more and more automated functions, such as distance and lane-keeping assist systems. At the same...
A research team led by physicists at the Technical University of Munich (TUM) has developed molecular nanoswitches that can be toggled between two structurally different states using an applied voltage. They can serve as the basis for a pioneering class of devices that could replace silicon-based components with organic molecules.
The development of new electronic technologies drives the incessant reduction of functional component sizes. In the context of an international collaborative...
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
25.05.2018 | Event News
02.05.2018 | Event News
13.04.2018 | Event News
25.05.2018 | Event News
25.05.2018 | Machine Engineering
25.05.2018 | Life Sciences