Ghafoor Virginia L, Epshteyn Mikhail, Carlson Gary H, Terhaar Donald M, Charry Orlando, Phelps Pamela K
Pain Management, Pharmacy Department, University of Minnesota Medical Center (UMMC), Minneapolis 55454, USA.
Am J Health Syst Pharm. 2007 Dec 1;64(23):2447-61. doi: 10.2146/ajhp060204.
The use, safety, and efficacy of intrathecal medication administration with implantable pumps for cancer and chronic pain management are reviewed.
Implanted intrathecal drug-delivery systems (IDDSs) are used for long-term management of persistent, severe pain despite a multimodal approach with conventional pain treatment options. Currently, consensus papers published in the literature are used as guidelines for determining patient selection and medication administration, because there is a lack of supporting evidence from randomized, controlled, clinical trials. Pharmacists have a critical role in the safe use of intrathecal medication. Most of the medication concentrations and combinations administered through IDDSs are not commercially available and therefore must be compounded in a pharmacy. Medications commonly administered through IDDSs include opioids, local anesthetics, clonidine, baclofen, and ziconotide. It is important for pharmacists who prepare products for IDDSs to understand the pharmacology, adverse effects, and concentration limitations of each medication in order to prevent adverse events related to postoperative subarachnoid hemorrhage, infection, catheter-tip inflammatory masses, withdrawal, and overdose. Pharmacists play an important role in maintaining quality assurance of intrathecal drug use, including the use of standard procedures for ordering and compounding medications, documentation of patient education, and monitoring of patient outcomes.
The use of long-term intrathecal drug delivery for the treatment of intractable pain or intolerable medication adverse effects has expanded to include the treatment of patients with chronic or cancer-related pain. Important considerations for the use of intrathecal drug therapy include the appropriate selection of patients, delivery systems, and medications, as well as potential complications of therapy and quality-assurance measures necessary to ensure patient safety.
综述植入式泵鞘内给药用于癌症和慢性疼痛管理的使用情况、安全性及有效性。
尽管采用了多种传统疼痛治疗方法，但植入式鞘内药物输送系统（IDDSs）仍用于长期管理持续性剧痛。目前，由于缺乏随机对照临床试验的支持证据，文献中发表的共识性文章被用作确定患者选择和给药的指导原则。药剂师在鞘内药物的安全使用中起着关键作用。通过IDDSs给药的大多数药物浓度和组合并非市售可得，因此必须在药房进行配制。通过IDDSs常用给药的药物包括阿片类药物、局部麻醉药、可乐定、巴氯芬和齐考诺肽。为IDDSs制备产品的药剂师了解每种药物的药理学、不良反应和浓度限制非常重要，以预防与术后蛛网膜下腔出血、感染、导管尖端炎性肿块、戒断和过量相关的不良事件。药剂师在维持鞘内药物使用的质量保证方面发挥着重要作用，包括使用标准程序订购和配制药物、记录患者教育情况以及监测患者预后。
长期鞘内药物输送用于治疗顽固性疼痛或难以耐受的药物不良反应已扩展至包括治疗慢性或癌症相关疼痛的患者。鞘内药物治疗的重要考虑因素包括患者、输送系统和药物的适当选择，以及治疗的潜在并发症和确保患者安全所需的质量保证措施。
