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Intraventricular
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.85 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. 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.274; 356
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