Abstract ID: A10

Abstract Title: Intrathecal Droperidol: An Innovative Application for Control of Intractable Nausea and Emesis

Authors: Stearns L¹, Berryman E², Hollander J³, Bell L⁴
Valley Cancer Pain Treatment Center Scottsdale AZ US¹, Midwestern University Glendale AZ US², Valley Cancer Pain Treatment Center Scottsdale AZ US³, Midwestern University Glendale AZ US⁴
Poster Type: Poster

ABSTRACT BODY

Purpose:
Evaluate the effectiveness of intrathecal droperidol (ITD) as an admixture for relief of refractory nausea and emesis secondary to cancer treatment.

Two-Phase-Setting:
173 patients from a cancer pain treatment center with an implantable drug infusion system (IDS) examined retrospectively. Five patients followed prospectively during RTC pilot.

Time frame:
January2004-July2005

Methods:
Retrospective chart review conducted on patients with an IDS. Pilot to proposed RTC, 5 IDS patients followed prospectively.

Data collected: demographics, nausea etiology (opioid intolerance, abdominal tumors, chemotherapy, radiation), nausea resolution, oral anti-emetic usage.

Results:
Among 173 patients, 21 males and 20 females with a mean age of 54 years, 41 (24%) initially received ITD for nausea. The etiology of intractable nausea was 46% opioid intolerance (oral and/or intrathecal), 49% abdominal tumor, and 5% chemotherapy or radiation induced nausea. ITD alone provided persistent resolution of nausea in 33 (81%) ITD plus other oral anti-emetics improved nausea in 5 (12%), while ITD plus a decrease in opioids improved nausea in 1 (2%). While 2 (5%), (one with brain metastases and one with liver failure) had no improvement in nausea symptoms.

Among pilot 4 (80%) had excellent nausea control w/in 4-5 days of droperidol administration.

Conclusions: ITD improved or resolved nausea in over 95% of patients in the retrospective study. Preliminary pilot data gathered for the purpose of establishing key metrics and effective collection methods produced these findings: Stratification by emetogenic potential (none, minimal, extensive). Time to minimum score (i.e. days required for patient to report lowest nausea score of recorded period), none= 2-6 days, minimal= 4 days, extensive = inconclusive resolution. Pilot data suggests patients with zero to minimal reach plateau of persistent resolution within seven-day timeframe. Future directions include a prospective, randomized double blind controlled trial to validate the findings from the chart review and pilot.

ATTACHED FILES

Reg Anesth Pain Med 2005; 30(3):A10