Epidural methadone results in dose-dependent analgesia in cancer pain, further enhanced by epidural dexamethasone

• Published in: British journal of cancer Vol. 108; no. 2; pp. 259 - 264
• Main Authors: Lauretti, G R, Rizzo, C C, Mattos, A L, Rodrigues, S W
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 05-02-2013; Nature Publishing Group
• Subjects: 631/154/436/108; 692/1807/410; 692/699/67; Adult; Aged; Analgesia, Epidural; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cancer therapies; Clinical Study; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Dexamethasone - therapeutic use; Drug Administration Routes; Drug dosages; Drug Resistance; Epidemiology; Epidural; Female; Humans; Lidocaine - administration & dosage; Lidocaine - adverse effects; Lidocaine - therapeutic use; Male; Medical sciences; Methadone; Methadone - administration & dosage; Methadone - adverse effects; Methadone - therapeutic use; Middle Aged; Molecular Medicine; Morphine; Narcotics; Neoplasms - physiopathology; Oncology; Pain; Pain - drug therapy; Pain Management; Tumors; cancer pain; epidural methadone; epidural dexamethasone; Corticosteroid; Dexamethasone; Steroid hormone; Opiates; Methadone; Malignant tumor; Extradural; Analgesia; Cancerology; Pain; Dose; Cancer
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2012.593

Background:
This study was designed to evaluate the role of epidural methadone-lidocaine in cancer pain combined or not to epidural dexamethasone.
Methods:
In all, 72 cancer patients, 32- to 67-year-old were randomized to six groups (
n
=12) and prospectively studied to examine analgesia and adverse effects for 3 weeks. Patients received single-dose protocol epidural test drugs: Control group (CG) received epidural 40-mg lidocaine diluted to 10-ml volume with saline. Dexamethasone group (DG) 40-mg lidocaine plus 10-mg dexamethasone. The 2.5MetG 2.5-mg epidural methadone with 40-mg lidocaine; the 5MetG, 5-mg epidural methadone plus 40-mg lidocaine, the 7.5MetG, 7.5-mg epidural methadone plus 40-mg lidocaine and finally the 7.5Met-DexG, 7.5-mg methadone with 40-mg lidocaine and 10-mg dexamethasone.
Results:
Groups CG, DG and 2.5MetG were similar regarding analgesia and side effects. Patients from 5MetG and 7.5MetG took 3±1 and 5±1 days, respectively, to restart oral morphine. Patients from 7.5MetDG took 14±2 to restart oral morphine (
P
<0.001). Daily somnolence and appetite improved in the 7.5MetDG during 2-week evaluation (
P
<0.005). Fatigue improved for both DG and 7.5MetDG during 2-week evaluation (
P
<0.005). By the third week of evaluation, all patients were similar.
Conclusions:
Epidural methadone plus lidocaine resulted in dose-dependent analgesia, further improved by epidural dexamethasone, which also improved fatigue.