Authors: Long D, Li X, Zhang Y, Luo J, Liu B, Hong B, Yang F, Zou C, Ge F, Zhang A, Zhou H, Xiao Y, Wang Y
Anesthesia & Analgesia 141(2): 255-263, August 2025.
This multicenter retrospective study evaluated the safety and efficacy of placing an intrathecal morphine pump catheter into the prepontine cistern for patients suffering from intractable craniofacial cancer pain. Conducted across eleven centers from 2019 to 2023, the study included 33 patients with severe, treatment-resistant pain.
Results showed dramatic improvement: median pain scores dropped from 8 preoperatively to just 1–2 by day 30. Breakthrough pain episodes also decreased substantially, from a median of 6 per day to nearly zero within a month. Importantly, almost all patients (96.7%) experienced at least 50% pain relief by day 30, and many achieved more than 75% relief. Systemic morphine use fell from a median of 228 mg/day to virtually none after implantation. Side effects were minimal and included nausea, constipation, urinary retention, and sedation, with no severe complications reported.
These findings suggest that targeted drug delivery into the prepontine cistern provides a powerful, safe, and opioid-sparing strategy for managing otherwise unrelenting craniofacial cancer pain.
Practical takeaway: For patients with refractory craniofacial cancer pain, prepontine cistern catheter placement should be considered as an advanced pain management option when conventional approaches fail.
KEY POINTS
- Question: Is placing the catheter of a morphine pump in the prepontine cistern safe and effective for patients with craniofacial cancer pain?
- Findings: This retrospective study of 33 patients in eleven medical centers demonstrated that placing a morphine pump into the prepontine cistern could effectively alleviate refractory craniofacial cancer pain with few adverse events.
- Meaning: In this study, prepontine cistern intrathecal targeted drug delivery provided another choice for adequate pain management in these patients with craniofacial cancer pain.
Thank you to Anesthesia & Analgesia for publishing this important work.