Intrathecal pain pump infusions for intractable cancer pain: an algorithm for dosing without a neuraxial trial.

Publication Type	Academic Article
Authors	Malhotra V, Root J, Kesselbrenner J, Njoku I, Cubert K, Gulati A, Puttanniah V, Bilsky M, Kaplitt M
Journal	Anesth Analg
Volume	116
Issue	6
Pagination	1364-70
Date Published	04/04/2013
ISSN	1526-7598
Keywords	Analgesics, Opioid, Infusion Pumps, Neoplasms, Pain, Intractable
Abstract	BACKGROUND: Patients with pain from advanced cancer often have limited life expectancy. Undergoing an epidural trial for placement of an intrathecal pump in these selected patients can exhaust limited days of life. We sought to analyze historical data at our cancer center to develop an algorithm to predict initial intrathecal pump dosing based on the starting preimplant systemic opioid regimen, thus averting an epidural trial and minimizing hospital stay. METHODS: We used data pre- and postpump from 46 cancer patients receiving systemic opioids undergoing intrathecal pump placement in the last 6 years, all of whom had undergone an epidural trial before pump placement. RESULTS: By analyzing intrathecal opioid dosage on discharge (in IV morphine equivalents) to age, type of pain, cancer type, preimplant opioid dose, and preimplant pain score using multiple regression, we created an algorithm that predicts, for cancer patients, an appropriate initial dose for an intrathecal pump based on the prepump systemic opioid dose, thus avoiding an epidural trial. The predicted value does have a broad 95% prediction interval (-122.7% to 147.6%) pointing to the value of a trial when feasible. CONCLUSIONS: When an epidural trial is not feasible and an intrathecal pump is required in a cancer patient, it is possible to predict an initial dose for the intrathecal pump based on the systemic opioid usage. This minimizes delays in achieving satisfactory analgesia and discharge to home.
DOI	10.1213/ANE.0b013e31828d670e
PubMed ID	23558833
PubMed Central ID	PMC5529040