Articles: palliative-care.
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Journal of neurosurgery · Aug 1984
Cancer pain relief using chronic morphine infusion. Early experience with a programmable implanted drug pump.
Fourteen patients were implanted with drug pumps to provide chronic epidural or intrathecal morphine to relieve pain due to cancer. A new programmable pump was used in seven of the patients and a constant infusion device was used in the other seven patients. ⋯ The programmable device has the obvious advantage of being able to vary dose according to patient need and requires less frequent refilling. Four programmable pump failures occurred, two requiring replacement.
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The records of 125 consecutive patients with unresectable pancreatic cancer treated between 1958 and 1979 were evaluated to determine the benefit or morbidity of gastroenterostomy performed on a routine basis. One hundred three patients had no evidence of gastric outlet obstruction from tumor extension as determined at the time of initial operation. Fifty-seven of these patients underwent biliary diversion as their only operative procedure. ⋯ Forty-six patients underwent both biliary and prophylactic gastric outlet diversion with a 15 percent mortality rate and a 46 percent incidence of morbidity. The most common complication in this group was delayed gastric emptying (14 percent). These findings, and the high incidence of delayed gastric emptying after gastroenterostomy and the relatively infrequent occurrence of gastric outlet obstruction (11 percent) after initial biliary diversion, suggest that gastroenterostomy should be performed on a selective basis only.
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One hundred and seventy-eight patients undergoing total hip replacement and 67 patients undergoing spinal surgery were given diamorphine intrathecally in varying doses. Doses in mg/kg were plotted against duration of analgesia and the absence of retention and emetic symptoms in each type of surgery. Analysis showed that these were not dose dependent within the therapeutic range of 0.005-0.015 mg/kg.
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Continuous infusion of drugs via an implantable infusion system offers advantages that are not available with other methods of drug delivery. For patients who require frequent drug injections, a continuous drug level, or high local concentrations, an implantable pump may assure compliance, comfort, and an improved therapeutic response. This method of drug delivery has been shown to be reliable and well tolerated by patients in numerous clinical trials. ⋯ At the present time regional infusion chemotherapy and intraspinal narcotic infusion for cancer pain seem to be most frequently encountered in a hospice setting. However, other uses for these implantable infusion systems are rapidly being developed, and this means of drug delivery probably will become more common in the next few years. One of the goals of continuous drug infusion by implantable pumps--optimal medical care without confining the patient to a hospital bed--is eminently compatible with the philosophy of hospice care.