• Ibrahim Egemen Ertaş, Salim Sehirali, Serpil Ozsezgin Ocek, Muzaffer Sancı, Gulderen Arbak, and Yusuf Yıldırım.
• Department of Gynecologic Oncology, Aegean Obstetrics and Gynecology Training and Research Hospital, İzmir, Turkey. drertas@gmail.com.
• Agri. 2014 Jan 1; 26 (1): 8-14.

ObjectiveWe aimed to evaluate the effectiveness of subcutaneously implanted epidural ports (SIEP) in the management of patients with advanced-stage gynecologic cancer-related severe chronic pain who do not respond to intravenous tramadol infusion, transdermal fentanyl, and oral morphine administration or who cannot tolerate the unacceptable and unmanageable side effects of these drugs.MethodsIn this prospectively designed study, SIEP to permit the administration of morphine were implanted for relief of severe chronic pain in 21 cases with stage IV gynecological cancer (ovarian [n=6], endometrium [n=3], cervix [n=10], vaginal [n=1], and vulvar [n=1]). In order to define the level of pain, visual analogue scale (VAS) and patient satisfaction score (PSS) were used before and on the 5th, 15th, and 30th days after epidural port application.ResultsThe mean overall survival period of the cases undergoing epidural port application was 80 days (range: 31-560). In terms of pain parameters, values at the end of the 5th, 15th and 30th days (VAS2, VAS3 and VAS4) were significantly lower than the value before morphine application via SIEP (VAS1) (p<0.01). PSSs at the 5th, 15th and 30th days were significantly higher than the PSS before port implantation (p<0.05). Pain management was started with 2 mg morphine with a maximum of 4 mg morphine administered into the epidural space per day. No clinically detected infectious condition or morphine-related side effects that required treatment occurred during the follow-up.ConclusionMorphine administration via SIEP provided excellent pain relief without creating side effects, increased patient quality of life, and contributed to the patient's ability to enjoy life.

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