Use of Implanted Epidural Catheter for Opioid Delivery Appears Safe, Effective in Home Setting

NEW YORK-An implanted epidural catheter can be a safe and effectivemeans of providing analgesia in the home setting for patientswith advanced cancer, Memorial Sloan-Kettering Cancer Center researchersfound in a retrospective review.

Angela Racolin, RN, and her colleagues in the Anesthesiology PainManagement Group examined the charts of 40 cancer patients referredfor management of inadequate analgesia or intolerable opioid sideeffects.

These patients lived an average of 2.3 months after catheter implantation,with 85% dying at home, the majority with satisfactory pain reliefprovided by the epidural till the end.

"Most patients do deteriorate as their disease progresses,requiring multiple dosage changes," Ms. Racolin said in aninterview, "but we can usually do that with the home careagencies over the telephone, so patients can remain in their homes."

In her poster presentation, Ms. Racolin said that in this seriesof patients, there were no serious complications associated withthe epidural catheters or with the medications used-hydromorphone(Dilaudid), morphine, and fentanyl (Sublimaze).

One catheter had to be removed due to infection 7 months afterinsertion, and one catheter became dislodged 6 weeks after implantation.

Cost analysis showed an average charge of $200 to $600/day, dependingon the choice of analgesic drug and home care company. In thesepatients, with a life expectancy of 2.3 months, the total costper patient of epidural drug delivery with home nursing care rangedfrom $21,000 to $42,000.

"In our practice, there are patients who can't tolerate sufficientoral or parenteral medication to keep them comfortable, and theother options, such as regional nerve block or periodic epiduralbolus doses, may not be appropriate," she said. "Forthese patients, we view epidural delivery as a very viable, albeitexpensive, option."

Although less invasive methods are always tried first, "thecontroversy," she said, "is, how long do you put a patientthrough trials of different opioids before you go to an epidural?I don't think anyone has definitive guidelines about this, andit's going to be different for different people with differentkinds of disease."