用于癌症疼痛管理的硬膜外阿片类药物和局部麻醉剂。

Epidural opiates and local anesthetics for the management of cancer pain.

作者信息

Hogan Quinn, Haddox David J, Abram Stephen, Weissman David, Taylor Mary Lou, Janjan Nora

机构信息

Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A. Department of Psychiatry, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A. Department of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A. Department of Radiation Therapy, Medical College of Wisconsin, Milwaukee, WI 53226 U.S.A.

出版信息

Pain. 1991 Sep;46(3):271-279. doi: 10.1016/0304-3959(91)90110-J.

DOI:10.1016/0304-3959(91)90110-J

PMID:1758711

Abstract

The role of epidural morphine in chronic cancer pain treatment is unresolved. In a population of 1205 cancer patients, the aggressive use of systemic opiates limited the trial of epidural analgesia to 16 cases. Successful analgesia was achieved with epidural morphine alone in 6 of these 16 cases following systemic opiate failure. The addition of bupivacaine produced analgesia in all of the 10 remaining cases and was successful chronically in 6 cases. Complications occurred in 11 of the 16 cases of epidural analgesia and included dislodged or broken catheters, pain on injection, hyperesthesia from epidural morphine and bleeding or infection related to the epidural catheter. Epidural morphine is indicated only in selected cancer pain patients and, although bupivacaine extends the efficacy of epidural analgesia, these methods are accompanied by problems and limitations.

摘要

硬膜外注射吗啡在慢性癌痛治疗中的作用尚未明确。在1205名癌症患者群体中，由于大量使用全身性阿片类药物，硬膜外镇痛试验仅纳入了16例患者。在这16例患者中，有6例在全身性阿片类药物治疗失败后，单独使用硬膜外吗啡成功实现了镇痛。在其余10例患者中，添加布比卡因后均产生了镇痛效果，其中6例长期有效。16例硬膜外镇痛患者中有11例出现了并发症，包括导管移位或折断、注射时疼痛、硬膜外吗啡引起的感觉过敏以及与硬膜外导管相关的出血或感染。硬膜外吗啡仅适用于特定的癌痛患者，尽管布比卡因可延长硬膜外镇痛的疗效，但这些方法仍存在问题和局限性。