When would one use intrathecal versus epidural analgesia for cancer pain management?
Both epidural and intrathecal analgesia systems allow the pain specialist to deliver a wide variety of opioids, local anesthetics, and adjuvants (e.g., clonidine, baclofen) directly into the central nervous system. This allows for smaller dosing and potentially less side-effects. In particular, the use of local anesthetics enables denser analgesia and a pos-sible opioid sparing effect.
Permanent intrathecal analgesia reservoirs are more expensive to place than externalized epidural infusion systems but are less expensive to maintain in the long term. If the prognosis for life expectancy is greater than approx-imately 3–4 months, the intrathecal analgesia system with an internal pump is financially preferable.