PMID- 34181790
OWN - NLM
STAT- MEDLINE
DCOM- 20211026
LR  - 20220210
IS  - 1525-1403 (Electronic)
IS  - 1094-7159 (Linking)
VI  - 24
IP  - 7
DP  - 2021 Oct
TI  - First Evaluation Switching From Ropivacaine to Highly Concentrated Bupivacaine in 
      Intrathecal Mixtures for Cancer Pain.
PG  - 1215-1222
LID - 10.1111/ner.13469 [doi]
AB  - BACKGROUND: Intrathecal drug delivery is widely used for intractable cancer pain 
      treatment. A combination of drugs with morphine and bupivacaine is recommended in 
      first line therapy. In France, we use ropivacaine 10 mg/mL instead of bupivacaine 
      5 mg/mL, the only concentration available. Bupivacaine 40 mg/mL has been 
      available in France only since July 2020 under temporary authorization of use. 
      OBJECTIVES: The main objective of the study was to evaluate the safety, efficacy 
      by pain assessment, to analyze drug dosage changes, to report adverse events 
      (AEs) and conversion ratios switching from ropivacaine to bupivacaine. Secondary 
      objective was to evaluate costs differences. MATERIALS AND METHODS: We conducted 
      this retrospective follow-up monocentric study within the Institut de 
      Cancerologie de l'Ouest (ICO) Pain Department in Angers, France. We included 14 
      patients aged 18 years and above, implanted with an Intrathecal Drug Delivery 
      Systems (IDDS) for cancer pain treatment and followed up at ICO from July 2020 to 
      February 2021 after switching from ropivacaine to bupivacaine. We used a 
      continuous infusion mode and Bolus could be added through Personal Therapy 
      Manager (PTM). RESULTS: The median conversion ratio between ropivacaine and 
      bupivacaine was 0.68 (0.65; 0.69) and resulted in no significant change in 
      numeric rating scale evaluation (p = 0.10). We observed moderate and rapidly 
      reversible AEs such as clinical hypotension (29%) and motor block after bolus 
      (21%). The estimated median hospital cost per day was significantly lower 
      (p = 0.05) for the bupivacaine refills than for the last ropivacaine pump refill, 
      decreasing from US$ 61.7 (49.6; 70.5) to US$ 50.4 (45.9; 60.4). The median 
      reimbursement per day from the National Health Insurance (NHI) was three times 
      lower for bupivacaine pump refill when compared to the last ropivacaine pump 
      refill (p < 0.01), decreasing from US$ 179.10 (156.79; 182.91) to US$ 64.59 
      (59.85; 71.89). CONCLUSION: Switching from ropivacaine to bupivacaine in IDDS 
      appears more efficacious while remaining just as secure, and at lower cost.
CI  - (c) 2021 International Neuromodulation Society.
FAU - Bienfait, Florent
AU  - Bienfait F
AUID- ORCID: 0000-0002-5940-4099
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
FAU - Jubier-Hamon, Sabrina
AU  - Jubier-Hamon S
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
FAU - Seegers, Valerie
AU  - Seegers V
AD  - Department of Epidemiology and Biostatistics, Institut de Cancerologie De 
      l'Ouest, Angers, France.
FAU - Pluchon, Yves-Marie
AU  - Pluchon YM
AD  - Pain Department, CHD-Vendee, La Roche-sur-Yon, France.
FAU - Lebrec, Nathalie
AU  - Lebrec N
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
FAU - Jaoul, Virginie
AU  - Jaoul V
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
FAU - Bore, Francois
AU  - Bore F
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
FAU - Delorme, Thierry
AU  - Delorme T
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
FAU - Robert, Julien
AU  - Robert J
AUID- ORCID: 0000-0001-7660-6509
AD  - Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France.
FAU - Bellanger, Martine
AU  - Bellanger M
AD  - Department of Human and Social Sciences, Institut de Cancerologie de l'Ouest, 
      Nantes, France.
AD  - EHESP School of Public Health, Paris, France.
FAU - Sorrieul, Jeremy
AU  - Sorrieul J
AUID- ORCID: 0000-0002-1653-1899
AD  - Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France.
FAU - Dupoiron, Denis
AU  - Dupoiron D
AUID- ORCID: 0000-0003-1777-2130
AD  - Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de 
      l'Ouest, Angers, France.
LA  - eng
PT  - Journal Article
DEP - 20210628
PL  - United States
TA  - Neuromodulation
JT  - Neuromodulation : journal of the International Neuromodulation Society
JID - 9804159
RN  - 0 (Amides)
RN  - 0 (Anesthetics, Local)
RN  - 7IO5LYA57N (Ropivacaine)
RN  - Y8335394RO (Bupivacaine)
SB  - IM
MH  - Amides
MH  - Anesthetics, Local
MH  - Bupivacaine
MH  - *Cancer Pain/drug therapy
MH  - Double-Blind Method
MH  - Humans
MH  - *Neoplasms
MH  - Retrospective Studies
MH  - Ropivacaine
OTO - NOTNLM
OT  - Bupivacaine
OT  - IDDS
OT  - cancer pain
OT  - intrathecal admixtures
OT  - ropivacaine
EDAT- 2021/06/29 06:00
MHDA- 2021/10/27 06:00
CRDT- 2021/06/28 17:24
PHST- 2021/04/23 00:00 [revised]
PHST- 2021/04/02 00:00 [received]
PHST- 2021/05/17 00:00 [accepted]
PHST- 2021/06/29 06:00 [pubmed]
PHST- 2021/10/27 06:00 [medline]
PHST- 2021/06/28 17:24 [entrez]
AID - S1094-7159(21)06458-8 [pii]
AID - 10.1111/ner.13469 [doi]
PST - ppublish
SO  - Neuromodulation. 2021 Oct;24(7):1215-1222. doi: 10.1111/ner.13469. Epub 2021 Jun 
      28.