[Home terminal care for terminal gastric cancer patients--case of epidural morphine injection].Gan To Kagaku Ryoho. 1994 Dec; 21 Suppl 4:497-500.GT
Pain management at home for a terminal gastric cancer patient unable to take medications orally was made possible by a combination of serial morphine drip infusion and epidural anesthesia with morphine on a continuing basis using a disposal syringe. Before the patient was discharged, a conference was held to prepare for home care. Besides the patient and family, it was attended by the primary care doctor, ward nurse, home nurse, pharmacy staff, pain clinic doctor and hospital office personnel. The patient was duly informed of the disease by name and, thanks to fine cooperation from the medical staff, had achieved a good understanding, and spent his remaining time meaningfully. Morphine dosages upon discharge were 80 mg/day by drip infusion and 90 mg/day epidurally. For times of increased pain, the patient was instructed in how to self-administer 0.5% Mepivacaine (5 ml/time) with a syringe using an epidural catheter equipped with a 3-way stopcock. When this proved insufficient to control the pain, the patient was instructed to come for outpatient treatment on an emergency basis. With one visit per week to the hospital and home visits by a nurse once or twice a week, the patient managed at home for 82 days before increased pain resulted in rehospitalization. After the pain was brought under control and the patient was discharged, he was again hospitalized 5 days later. The pain control up until the time of death was by drip infusion of up to 1,200 mg/day morphine.