• R T van Dongen, B J Crul, and J van Egmond.
• Department of Pain Treatment, Institute for Anesthesiology, University of Nijmegen, Sint Radboud Hospital, The Netherlands. R.vandongen@anes.azn.nl
• Clin J Pain. 1999 Sep 1;15(3):166-72.

ObjectiveTo determine the difference in intrathecal morphine dose progression between a continuous intrathecal infusion of a morphine/bupivacaine mixture and morphine for pain relief in patients with cancer.DesignPatients were treated with intrathecal drugs in a randomized study and followed prospectively until death.SettingInstitute for Anesthesiology, Department of Pain Treatment, University Hospital Nijmegen, St Radboud, The Netherlands.PatientsTwenty patients with cancer were selected for intrathecal treatment because of either side effects or inadequate relief during conventional pain treatment.InterventionsIntrathecal drug infusion rates and medication were adjusted according to pain relief and side effects.Outcome MeasuresProgression of intrathecal morphine dose during a phase of adequate analgesia in both groups following regression analysis and analysis of possible treatment related side effects.ResultsThe combination of intrathecal morphine and bupivacaine resulted in a diminished progression of the intrathecal morphine dose (slope of regression line = 0.0003 vs. 0.005, p = 0.0001) during a phase of stable analgesia in comparison with the morphine group. No serious side effects presented.ConclusionThe diminished intrathecal morphine dose increase in the combination group is considered to be due to a synergistic effect of bupivacaine on the intrathecal morphine-induced antinociception. A dose increment during long-term intrathecal infusion in cancer patients appears to be related to both disease progression and tolerance phenomena.

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