Neurohistopathological findings after continuous intrathecal administration of opioids and bupivacaine for pain treatment in cancer patients

<b>Introduction</b>: Few studies have examined neuropathological changes such as the degenerative necrosis and demyelination of spinal nerve cells accompanying intrathecal administration of opioids (ITO) to relieve refractory cancer pain. Previous studies have produced conflicting results as to whether or not ITO causes nerve tissue damage. The current study neuropathologically investigated autopsy specimens from patients who received ITO. <b>Methods</b>: Subjects were 7 patients who received continuous intrathecal analgesia and who were later autopsied (4 males, 3 females). Six patients were administered morphine and bupivacaine while 1 patient was administered fentanyl and bupivacaine. The duration of administration ranged from 6-345 days. <b>Results</b>: Two patients who received long-term administration of morphine were found to have severe necrotic degeneration and gliosis of spinal neurons and demyelination in the dorsal horn and dorsal roots. However, neuropathological changes were not noted in Patient 4, who was briefly administered morphine, or in the patient who was administered fentanyl. <b>Conclusion</b>: The total dose of morphine used for ITO and the duration of its administration were suggested to be related to the extent of nerve tissue damage. Thus, nerve tissue damage due to ITO might be primarily associated with morphine.

Symptom resolution by pericardial drainage in a terminal cancer patient with pericardial abscess following pericardial emphysema

A 42-year-old man with primary tongue cancer was admitted to our palliative care center for the control of pain due to multiple bone metastases. On 30th day after admission, he was suffering from pneumonia. And on 37th day, chest radiograph demonstrated pericardial emphysema, which developed to the pericardial abscess. Chest Computed Tomography showed lymph nodes metastases around the left main bronchus, and revealed that there was a fistula between the left main bronchus and the pericardium. The patient was faced to the difficulty in taking spine position because of excessive excretion of the sputum. Pericardiocentesis was then performed percutaneously and a tube for the drainage was placed. After the placement of drain tube, he restored good night sleep in the spine position and the complaints were reduced. Palliat Care Res 2008; 3(2): 321-325