PubMed Health⌕ Search

Biomedical subjects

Y Gestin

Publications and source records attributed to Y Gestin.

10 recordsLinked to original sources
PubMed1997

Long-term intrathecal infusion of morphine in the home care of patients with advanced cancer.

BACKGROUND: Fear of infections and other complications has made many clinicians avoid intrathecal application of morphine in chronic cancer pain. However, recent comparative studies show that, in long-term treatment, intrathecal morphine administration may give a more satisfactory pain relief with lower doses of morphine and fewer side-effects than epidural administration. In Montpellier Cancer Institute, first cancer pain patients received long-term intrathecal morphine as early as in 1979, and since then more than 400 patients have been treated. METHODS: In 1991-1994, 50 patients having refractory cancer pain were treated with a continuous intrathecal infusion of morphine using an external pump with patient-controlled boluses. In this retrospective study, the outcome of these 5602 days of morphine therapy will be analysed. The treatment consisted of a lateral puncture technique, strictly aseptic conditions during catheter insertion and changes of pump reservoirs, and effective prevention of side-effects. RESULTS: The average duration of intrathecal infusion was 142 (7-584) days. The mean starting dose, 2.5 (0.4-8.3) mg/day, increased to a mean final dose of 9.2 (1-94) mg/day, the average dose being 5.4 (1-23) mg/day. During the treatment period, no clinically detectable infections and no respiratory depression occurred. Leakage of cerebrospinal fluid followed by post-spinal headache occurred in only 6 patients who received a temporary external catheter: the lateral lumbar puncture technique seemed to protect from this complication in long-term treatment. The patients stayed at home, coming to agreed control visits only at 4-6 week intervals, using a telephone-telefax service for emergencies. CONCLUSIONS: Long-term intrathecal morphine infusion seems to provide satisfactory analgesia, few side-effects and a high degree of patient autonomy.

Adult↗
PubMed1986

[Long-term intrathecal isobaric morphine therapy].

In order to evaluate long-term intrathecal morphine therapy for cancer pain, whatever its location, 121 patients (80% were ambulatory patients) treated between April 1979 and April 1985 at the Cancer Institute of Montpellier (Centre Paul-Lamarque) were assessed. Morphine was stored in a presternal insulin syringe, protected by a sterile and waterproof dressing. A bolus administration of morphine via a subcutaneous lombo-epigastric subarachnoid catheter was scheduled every 12 h. This "closed" device was opened for refilling in an operating room only. The mean follow-up was 68 days (maximum: 13 months). More than 15,000 intrathecal injections were made. The mean daily amount of morphine required was 2.3 mg (extremes: 0.75 and 21 mg). All patients developed tolerance, requiring an adjustment of morphine dosages every 30 to 45 days. With the isobaric morphine solution, good or very good analgesia was achieved in 82% of patients, even in those suffering from thoracic or otolaryngologic pain. Mechanical complications (catheter coming out of the subarachnoid space in 7.67% of cases, leakage of CSF along the catheter in 9.16% of cases) were related to the exteriorization of the proximal catheter tip. With the exception of errors in manipulation, neither infection nor clinical respiratory depression were noticed. Nausea and vomiting were frequent but resolved spontaneously within a few days. Urine retention (33%) occurred mainly in men over 65 years, after pelvic surgery or radiotherapy. Because of the absence of a defined zone of analgesia, the small volumes required and the "ready for use" preparation, intrathecal isobaric morphine therapy will lead to easy self-administration via an implanted pump in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheters, Indwelling↗
PubMed1981

[Splanchnic nerve blocks by alcoholisation in pancreatico-solar hyperalgia of tumoral origin (author's transl)].

Fifty-eight coelio-splanchnic nerve blocks by alcoholisation were done for thirty-two patients at the regional Center of the Fight against Cancer at Montpellier for persistent neoplastic pain of the pancreatico-solar type. In 15 cases (46,6 p. cent), the pancreatico-solar syndrome is the initial sign of a primitive or secondary supra-mesocolic cancer. In 12 cases, the hyperalgic syndrome discloses the extension or recidive of the tumor. According to etiologies, the illnesses were as follows: --pancreatic neoplasias I or II: 13 cases, --hepato-biliary lesions I or II: 11 cases, --peritoneal carcinosis: 4 cases, --invasion of retro-peritoneal nodes: 4 cases. Epigastric pain irradiating to the left para-vertebral area are resistant to analgesias; 95 p. cent of these patients received morphinic drugs for several days, if not weeks. The splanchnic nerves were reached by a posterior high lumbar injection according to the Kappis and Labat technic. A block with 2 p. cent lidocaine is immediately followed by alcoholisation by 99,8 p. cent ethanol. According to patient status, the blocks to the left and right were done at once or at several visits. The block by lidocaine gives immediate analgesia thereby indicating the proper placement of the injection. The coeliac alcoholisation assures the neurolysis of the splanchnic nerves. The antalgic effect lasts a variable time, averaging 42 days (varying from 2 to 240 days). The antalgic action always allows the discontinuation of morphinic drugs and increases the efficacy of minor analgesics, if necessary. All the same, 18/25 received morphine during their last few days before death.

Adult↗