The evidence of neuraxial administration of analgesics for cancer-related pain: a systematic review G. P. Kurita 1 , K. S. Benthien 2,3 , M. Nordly 2,3 , S. Mercadante 4,5 , P. Klepstad 6,7 , P. Sjøgren 2,3 , and On behalf of the European Palliative Care Research Collaborative (EPCRC) 1 Section of Palliative Medicine, Department of Oncology, Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark 3 Department of Oncology, Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark 4 Anesthesia and Intensive Care Unit, Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy 5 Department of Anesthesia, Intensive Care & Emergencies, University of Palermo, Palermo, Italy 6 Department of Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway 7 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway Correspondence G. P. Kurita, Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Blegdamsvej 9, Dept. 4111, Copenhagen 2100, Denmark E-mail: geana.kurita@regionh.dk Conflict of interest The authors have declared no conflicts of interest. Funding No funding was received to develop this study. Submitted 21 October 2014; accepted 12 January 2015; submission 17 September 2014. Citation Kurita GP, Benthien KS, Nordly M, Mercadante S, Klepstad P, Sjøgren P, On behalf of the European Palliative Care Research Collaborative (EPCRC). The evidence of neuraxial administration of analgesics for cancer-related pain: a systematic review. Acta Anaesthesiologica Scandinavica 2015 doi: 10.1111/aas.12485 Background: The present systematic review analysed the existing evidence of analgesic efficacy and side effects of opioids without and with adjuvant analgesics delivered by neuraxial route (epidural and subarachnoid) in adult patients with cancer. Methods: Search strategy was elaborated with words related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation. Results: The number of abstracts retrieved was 2147, and 84 articles were selected for full reading. The final selection comprised nine articles regarding randomised controlled trials (RCTs) divided in four groups: neuraxial combinations of opioid and adjuvant anal- gesic compared with neuraxial administration of opioid alone (n = 4); single neuraxial drug in bolus compared with continuous administration (n = 2); single neuraxial drug compared with neur- axial placebo (n = 1); and neuraxial opioid combined with or without adjuvant analgesic compared with other comprehensive medical management than neuraxial analgesics (n = 2). The RCTs presented clinical and methodological diversity that precluded a meta-analysis. They also presented several limitations, which reduced study internal validity. However, they demonstrated better pain control for all interventions analysed. Side effects were described, but there were few significant differences in favour of the tested interventions. Conclusion: Heterogeneous characteristics and several method- ological limitations of the studies resulted in evidence of low quality and a weak recommendation for neuraxial administration of opioids with or without adjuvant analgesics in adult patients with cancer. Editorial comment: what this article tells us Neuraxial (epidural and intrathecal) drug administration is an established anaesthesiological treat- ment for intractable cancer-related pain. This systematic review tells us that the evidence base for this type of invasive therapy is diverse and meagre. REVIEW ARTICLE Acta Anaesthesiologica Scandinavica (2015) © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd 1