Kurita, G.P., Benthien, K.S., Nordly, M., Mercadante, S., Klepstad, P., Sjogren, P., & European Palliative Care Research Collaborative (EPCRC). (2015). The evidence of neuraxial administration of analgesics for cancer-related pain: A systematic review. Acta Anaesthesiologica Scandinavica, 59, 1103–1115. 

STUDY PURPOSE: To review the evidence for the intraspinal administration of analgesics for refractory cancer-related pain

TOTAL REFERENCES RETRIEVED: 2,672

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: A four-point quality scoring system was described.

• FINAL NUMBER STUDIES INCLUDED = 9
• TOTAL PATIENTS INCLUDED IN REVIEW = Not provided
• SAMPLE RANGE ACROSS STUDIES: Not provided
• KEY SAMPLE CHARACTERISTICS: Not provided

PHASE OF CARE: End of life care
 
APPLICATIONS: Palliative care

Four studies compared combinations of opioids and adjuvant drugs to opioids alone. Two studies compared a neuraxial drug bolus with a continuous infusion, one study compared a single drug with a placebo, and two studies compared neuraxial drug administration with comprehensive medical management. Pain relief was reported in all studies comparing opioids alone or in combination with adjuvant drugs. Better analgesic effects were reported with continuous infusion compared to bolus infusion. Sample sizes were small, and the quality of the studies was low.

There was limited evidence regarding neuraxial analgesic administration for intractable pain in patients with cancer.

There were multiple methodologic concerns regarding study design and sample size. There were few studies for each type of study reviewed. Quality issues identified included loss to follow-up, unclear descriptions of setting, and no report of a power calculation. This review did not report sample sizes and graded items such as lack of setting description alone as equivalent to design issues.

There was limited evidence regarding the efficacy of intrathecal analgesic administration compared to other aggressive forms of pain control for patients with refractory pain, and the most effective drugs or drug combinations for this mode of delivery were not clear. Neuraxial treatment requires appropriate resources for safe administration and patient observation. Nurses have an important role to play regarding the selection of patients for safe home-based care delivery and the assessment of patient risks. Additional research comparing the efficacy of various aggressive pain management interventions is needed.