Salmon J B, Finch P M, Lovegrove F T, Warwick A
Perth Pain Management Centre, Applecross, Western Australia.
Clin J Pain. 1992 Mar;8(1):18-22. doi: 10.1097/00002508-199203000-00004.
This study used a radionuclide imaging technique to map the spread and density contours of phenol in glycerin injected into the epidural space of cancer patients. Correlations were made between phenol injectate volume, sequence of injection, position of patient, and resultant epidural spread and analgesic outcome. Fifteen patients with cancer pain (average age of 61 years) were treated with serial epidural phenol in glycerin injections. Phenol in glycerin is miscible with [99mTc]sulfur colloid. An assumption was made that the admixture injected epidurally was inseparable prior to absorption and the spread was recorded by continuous gamma camera observations with computer collection for 30 min postinjection. The spread of injectate volumes of 2, 3, and 4 ml were compared and further correlations made between observed spread and sequence of injections (first to fifth in series within each patient) and position of patient. Small volumes of phenol may spread extensively in the epidural space (3 ml spreads a mean 13.6 segments) with wide variation among patients. Initial phenol injections spread further than subsequent injections. Maximum spread is achieved by 15 min postinjection and epidural distribution is mostly uniform, independent of patient position. Good analgesia was obtained in 14 patients (93%). Epidural neurolysis using serial injections of small volumes of phenol in glycerin is an effective, safe technique for cancer pain relief. Injectate volumes larger than 3 ml may be unnecessary and potentially dangerous.
本研究采用放射性核素成像技术绘制注入癌症患者硬膜外腔的甘油中苯酚的扩散和密度轮廓图。对苯酚注射量、注射顺序、患者体位以及由此产生的硬膜外扩散和镇痛效果之间进行了相关性分析。15例癌症疼痛患者（平均年龄61岁）接受了连续硬膜外注射甘油苯酚治疗。甘油中的苯酚可与[99mTc]硫胶体混溶。假设硬膜外注射的混合物在吸收前不可分离，注射后通过伽马相机连续观察并计算机采集30分钟来记录扩散情况。比较了2、3和4毫升注射量的扩散情况，并进一步分析了观察到的扩散与注射顺序（每位患者系列中的第一至第五次）和患者体位之间的相关性。少量苯酚可能在硬膜外腔广泛扩散（3毫升平均扩散13.6节段），患者之间差异很大。首次苯酚注射比后续注射扩散得更远。注射后15分钟达到最大扩散，硬膜外分布大多均匀，与患者体位无关。14例患者（93%）获得了良好的镇痛效果。使用连续小剂量甘油苯酚注射进行硬膜外神经溶解是一种有效、安全的缓解癌症疼痛的技术。注射量大于3毫升可能不必要且有潜在危险。
