İbrahim Egemen ERTAŞ, Salim ŞEHİRALİ, Serpil ÖCEL ÖZSEZGİN, Muzaffer SANCI, Gülderen ARBAK, Yusuf YILDIRIM

The effectiveness of subcutaneously implanted epidural ports for relief of severe pain in patients with advanced-stage gynecological cancer: a prospective study

Amaç: İntravenöz tramadol infüzyonuna, transdermal fentanil ve oral morfin uygulamasına yanıt vermeyen ayrıca bu ilaçların kabul edilemeyen ve tedavi edilemeyen yan etkilerini tölere edemeyen; ileri evre jinekolojik kansere bağlı şiddetli kronik ağrısı olan hastaların yönetiminde subkutanöz yerleştirilen epidural portların etkinliğini değerlendirmektir. Gereç ve Yöntem: İleriye dönük çalışma dizaynına göre, evre IV jinekolojik kanserli 21 hastada (over n=6, endometrium n=3, serviks n=10, vajina n=1 ve vulva n=1) şiddetli kronik ağrının giderilmesi için morfin uygulanmasına imkan veren epidural portlar subkutanöz olarak yerleştirildi. Epidural port uygulamasından önce ve 5., 15. ve 30. günlerden sonra ağrının seviyesini tanımlamak üzere görsel analog skalası (GAS) ve hasta memnuniyeti skorlaması (HMS) kullanıldı. Bulgular: Epidural port uygulanan vakaların ortalama genel sağkalım süresi 80 gündü (dağılım 31-560). Ağrı parametreleri açı- sından, 5., 15. ve 30. günlerin sonundaki değerler (GAS2, GAS3 ve GAS4), epidural port yoluyla morfin uygulamasından önceki değerden (GAS1) anlamlı düşük idi (p

İleri evre jinekolojik kanserli hastalarda şiddetli ağrının giderilmesi için subkutanöz yerleştirilen epidural portların etkinliği: prospektif bir çalışma

Objective: We aimed to evaluate the effectiveness of subcutaneously implanted epidural ports (SIEP) in the management of patients with advanced-stage gynecologic cancer-related severe chronic pain who do not respond to intravenous tramadol infu- sion, transdermal fentanyl, and oral morphine administration or who cannot tolerate the unacceptable and unmanageable side effects of these drugs. Methods: In this prospectively designed study, SIEP to permit the administration of morphine were implanted for relief of severe chronic pain in 21 cases with stage IV gynecological cancer (ovarian [n=6], endometrium [n=3], cervix [n=10], vaginal [n=1], and vulvar [n=1]). In order to define the level of pain, visual analogue scale (VAS) and patient satisfaction score (PSS) were used before and on the 5th, 15th, and 30th days after epidural port application. Results: The mean overall survival period of the cases undergoing epidural port application was 80 days (range: 31-560). In terms of pain parameters, values at the end of the 5th, 15th and 30th days (VAS2, VAS3 and VAS4) were significantly lower than the value before morphine application via SIEP (VAS1) (p<0.01). PSSs at the 5th, 15th and 30th days were sig- nificantly higher than the PSS before port implantation (p<0.05). Pain management was started with 2 mg morphine with a maximum of 4 mg morphine administered into the epidural space per day. No clinically detected infectious condition or morphine-related side effects that required treatment occurred during the follow-up. Conclusion: Morphine administration via SIEP provided excellent pain relief without creating side effects, increased patient quality of life, and contributed to the patients ability to enjoy life.

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