EPIDURAL ANALGESIA USING HIGH DOSE MORPHINE IN TERMINAL LUNG CANCER PATIENT

초록

Introduction : Pain control is very important in treating terminal lung cancer patients and there are several modalities to alleviate the pain. Although morphine is used in general, its adverse effects such as nausea, vomiting, and itching sensation must be considered. Morphine is administered either via intravenous route or epidural route. The effect of epidural morphine is ten times of that of intravenous morphine, and it also reduces the total amount of the drug administered. Methods : A fifty-four years old male patient with non small cell lung cancer was referred to pain clinic to control his pain caused by bone-metastasis. He had received lovectomy of the lung followed by chemotherapy. After his first stellate ganglion block, epidural caheter was inserted between C7 and T1 and continuous epidural block was started with 4mg of morphine. Morphine dose was increased gradually to 180mg in 86 days. After that, ketamine was added to morphine regimen starting from 60mg with 180mg of morphine. Morphine and ketamine dose was increased to 2820mg and 700mg respectively in 8 months. Epidural catheter was changed periodically due to infection sign and accidental removal. Patients expired after 11 months of pain control. Results : In this case, high dose epidural morphine, specifically 2820mg, has been administered to control cancer pain. Even with this dose of morphine, there was no adverse effect such as dyspnea, and vomiting except occasional itching sensation. Conclusions : For terminal cancer pain patient, high dose morphine is necessary to control cancer pain and it is recommended for increasing the dose in stepwise fashion to minimize the development of complication. Furthermore, to decrease the amount of morphine administration, epidural route must be considered first over intravenous route and ketamine can be added to morphine regimen since it is considered to be helpful in cancer pain control.