[Patient-controlled Analgesia with Subcutaneous Opoids for Out-patients with Severe Tumour Pain.]

PCAO (patient-controlled analgesia in outpatients) is a new treatment concept designed to overcome chronic or acute pain of cancer patients. From 1989 to 1992, a total of with tumour pain 204 patients were treated in the pain clinics of Fürth in cooperation with the Department of Radiation at the University Hospital in Regensburg. In 90 of these patients adequate oral medication was impossible because of problems in swallowing or blockage of the gastrointestinal tract, and subcutaneous opioid infusion over 24 h was therefore instituted. The evaluation refers to 2311 days of treatment. While in 1989/90 only 35% (34/97) received subcutaneous opioid infusion, the proportion had already risen to 64% (54/84) by 1991/92. The proportion of patients who has to be treated as in-patients also fell: 26% in 1989/90, as against 10% in 1991/92. The subcutaneous infusion was well tolerated and accepted by the patients. In only 0.6% of cases was discontinuation necessitated by technical problems. Continuous subcutaneous applications of opioids is a highly effective therapeutic method with low risk and few side-effects. With the Perfusor M, the nurses and the patients can be trained to use the equipment. The patients can then administer boli themlselves when their pain is inadequately controlled. PCAO for treatment of cancer patients at home yields freedom from of pain around the clock, independence, and quality of life with active personal involvement. The most important thing is that the patient can sleep during the night, as can the doctor, the nurse and relatives, as they do not need to give injections during the night. This new method of treating the pain of cancer patients at home in advanced disease is also well accepted by social security authorities, as it reduces the costs dramatically.