Experience with intraventricular morphine administration is steadily
increasing, and results with this route compare favorably with those with
intraspin-al administration, with over 90 percent of patients in published
series benefitting significantly (Choi, Ha, Ahn, et al., 1989). Most important,
intraventricular morphine is beneficial for recalcitrant pain due to head and
neck malignancies and tumors (e.g., superior sulcus tumors, breast carcinoma)
that affect the brachial plexus. Small maintenance doses of morphine (less than
5 mg daily) are needed to achieve maximal comfort. Complications are rare, the
most important being infection; as with intraspinal drug delivery, tolerance
and respiratory depression do not appear to be major issues (Ballantyne, 1992).
Intraventricular morphine requires the placement of a ventricular catheter
connected to a subcutaneous (e g, Ommaya) reservoir for intermittent
administration or an infusion pump for continuous infusion (Lazorthes, Verdie,
Bastide, et al., 1985; Obbens, Hill, Leavens, et al. 1987).
Intravenous or Subcutaneous
Patient-Controlled Analgesia (PCA)