More than a third of small pelvis cancer cases in Uzbekistan are diagnosed in the late stages, where the main goal of medical interventions is to increase life expectancy with maximum maintenance of the quality of life. Opioid prescription and opiophobia in medical personnel make it harder to control pain in this group of patients, decreasing the quality of their life.
34 patients with locally advanced tumors of small pelvis (17 rectal cancer, 11 cervical cancer, 6 prostate cancer) with pain syndrome by visual analog scale (VAS) 8-10 were selected as the study group. Patients were treated in National cancer center of Uzbekistan in 2017-2020. Epidural catheter was placed in V4-5. Solution of bupivacaine 2.5% 20 ml with 1% of morphine injected at primary point. Then, 5 ml of bupivacaine 2.5% every 6 hours, 1 ml of 1% morphine every 12 hrs. Mean period of catheter placement was 23,6 days (7-36). in order to decrease the possibility of infection wide spectrum of antibiotics and wound dressing were administered. Control group included 34 patients with locally advanced tumors of small pelvis (20 rectal cancer, 12 cervical cancer, 2 prostate cancer) with pain syndrome by visual analog scale (VAS) 8-10. They underwent standard WHO pain ladder therapy morphine 1%-1 ml every 4-6 hrs ± ketorolac 30 mg – 1 ml.
Withing the 20 minutes of administering, median pain syndrome by VAS was 0.78 (0-4). 6 (17.6%) patients admitted headache, 3 dizziness (8.8%). 2 patients admitted 1st grade nausea (5.9%). Constipation was not admitted in the main group. Drowsiness was admitted in 7 patients (20.6%). All of the symptoms disappeared within the 7 days period of hospitalization. In control group, the mean pain syndrome was 4.6 (0-7) by VAS. Drowsiness effect was observed in 27 patients (79.4), however, 21 (61.8%) cases this effect regressed in 7-day period. In 3-months observation period, 11 (32.6) patients from second group had complains on constipation which was resolved with laxatives and enemas.
Analgesia with usage of long-term epidural catheter placement allowed to achieve better pain control, lower opioid usage and avoid severe complications in patients with severe chronic pain syndrome of small pelvis tumors.
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National Cancer Center of Uzbekistan.
National Cancer Center of Uzbekistan.
All authors have declared no conflicts of interest.