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ANAGELSIC EFFECT OF INTRACEREBROVENTRICULAR 271 Poster

(ICV) SOMATOSTATIN-14 (SOM-14), ARGININE VASO- PRESSIN (AVP) AND OXYTOCIN (OT) IN A PATIENT WITH

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TERMINAL CANCER PAIN. I. Madrazo*‘, R. Franco-Bourland*Z, V. Leon* and I. Mena*’ (SPON: R. de Lille), La Raza, IMSS and 21nst. Nal. Nutr., SZ, Mexico City, Mexico

We tested the analgesic effect of icv SOM-14, AVP, and OT in man. A 3rd ventricular catheter, connected to an Omaya-like reservoir was implan- ted for routine central analgesic therapy in a 46-year-old patient with a diffuse mesothelioma, suffering intractable continuous and incapacitating thoracic pain (left side; levels T4-TlO), in whom parenteral opiates were no longer effective. Before receiving the regular treatment with morphine and in accordance with all internationally recognized ethical standards, on different days of a 10 day experimental period, and under strict medical observation, the patient was given icv a single dose of SOM-14 (3OOpg). AVP (100,g) or OT (3OOug) in 1 ml of sterile phosphate buffered saline (PBS), and 1 ml PBS, as a placebo. The patient rated his pain on a % scale. Vital signs were recorded every 15 min. Between trials the patient was given intramuscularly 10 mg nalbuphine-HCl , a treatment discontinued at least 8h before peptide administration.

SOM-14 reduced pain by 90% for 48 min; AVP by 95% for 72 min. and OT by 88% for 77 min. The only notable side effects observed were the induc- tion by AVP of anesthesia and flaccid paralysis of the lower limbs with no sphincter relaxation from which the patient fully recovered after 20h. At the end of the study, the patient was successfully put on the regular morphine therapy and discharged.

Third ventricular SOM-14 and OT may be an alternative, and possibly non-addictive means of treating chronic pain, whereas AVP may be a useful anesthetic.

EPIDURAL KETAHINE vs EPIDURAL MORPHINE IN SEVERE CANCER PAIN V; Whizar-Lugo and C. Cortez Comet* Anesthesiology, Hospital de IS-S&

Pain Service, Dept of I, Tijuana BC; Mexico.

Aim of Investiqation: Although the analgesic properties of ketamine (K) I

have been well documented, the interaction of K with the opiate receptors remain in controversy. There are few clinical studies showing the efficacy of epidurallspinal K in the control of cancer pain. Our study compares the analgesic properties between epidural morphine (M) vs epidural K in the treatment of severe cancer pain.

Methods: We divided the patients in three groups: there were 9 patients in thet group, 5 cases in the second group and 6 patients in the third group. The patients in the first group were injected epidurally with 3 to 5 mg of M in 10 ml normal saline. The patients in the second group received epidural K 5 to 8 mg in 10 ml normal saline. Patients in the third group re ceived epidural K 20 mg in 10 ml normal saline. Either, M or K was injected when the visual analogue scale was Y-10 or before if the patient asked for analgesia.

Results: In the M group analgesia ranged from 70 % up to 100 X, lasting 6 t-The K analqesia was erratic and unpredictable, In the second group ranged from 15 to 65 %, lasting 1.5 to 4 h. In the-third group the analgesic effects were from 30 to 100 %, lasting 3 to 5 h. Pruritus was the more frequent side effect in the M group. There were no side effects in the K groups.

Conclusions: In rats, it has been demonstrated that intratecal K has less analgesic effect than M. Mankowitz obtained a dramatic and prolonged analgesic response to epidural K in cancer pain. Our results show that epi- dural K has less analgesic potency compared with epidural M. It is impor- tant to mention that hypothetically and clinically epidural K has no side- effects..