Retrospective consideration of the doses of morphine given intrathecally by chronic infusion in 163 patients by 19 physicians

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Abstract
A retrospective, multi-physician survey was carried out to examine the infusion concentrations of morphine delivered intrathecally by continuous infusion pumps placed to control pain. Replies from 19 physicians formed the basis for a population of 163 patients who received morphine by continuous infusion delivered by an Infusaid pump through a chronically implanted intrathecal catheter (N = 130 for pain of a metastatic origin; N = 3 for non-metastatic pain; N = 30 undefined). These patients received a total of 3443 patient weeks of infusion. The median infusion duration was 13 weeks (.+-. 1 quartile: 5-24 weeks). Examination of the concentrations employed revealed that the maximally employed concentration was 1 mg/ml (885 patient weeks). Of the 163 patients, 151 patients received no concentration of morphine sulfate higher than 10 mg/ml. The highest reported concentrations used were around 35 mg/ml. No pathological sequelae related to the infusion of any dose of the opiates were reported. Cumulating the experience with morphine solutions of 8, 9 and 10 mg/ml reveals a total of 472 patient weeks in 29 patients. Analysis of the change in infusion dose over time in cancer pain patients revealed a prominant time-dependent increase (N = 130) from 4.8 .+-. 0.4 mg/day (N = 130) to 21 .+-. 9 mg/day at 52 weeks (N = 10; mean .+-. S.E.M). Though the group morphine utilization rose, examination of the patient population which was infused for periods in excess of 3 months indicated that 48% showed less than a 2-fold increase in dose by 3 months.