Kurihara Yuka, Ikegaki Junichi, Kato Hiromi, Chigusa Suzuko, Kaetsu Hiroshi
Department of Anesthesia, The Hyogo Medical Center for Adults, Hyogo, Japan.
Masui. 2008 Feb;57(2):182-6.
A 48-year-old woman, diagnosed as colon cancer with metastases in the liver, lung, bone and left rectus abdominis, developed refractory left abdominal pain in spite of escalating administration of opioids and nerve block therapy, and intrathecal analgesia was applied. The tip of the catheter was intrathecally placed at the level of the T8 vertebra and pain relief was obtained with a daily dose of bupivacaine 36 mg producing segmental analgesia of the area between the 7th and 10th thoracic segments and preserving sensory and motor functions of the lower limbs. Face scale scores decreased from 5/6 to almost 0 after induction of the intrathecal analgesia. Side effects related to systemic opioids, such as nausea, vomiting and sleepiness, significantly improved and she was able to walk to the toilet. It is suggested that when the site of pain is limited to the truncus, intrathecal analgesia only with local anesthetics can be applied without affecting functions of the lower limbs.
一名48岁女性，被诊断为结肠癌伴肝、肺、骨及左腹直肌转移，尽管阿片类药物和神经阻滞治疗的剂量不断增加，仍出现顽固性左腹痛，遂应用鞘内镇痛。导管尖端鞘内置于T8椎体水平，每日给予布比卡因36mg可缓解疼痛，产生胸7至胸10节段的节段性镇痛，同时保留下肢的感觉和运动功能。鞘内镇痛诱导后，面部疼痛量表评分从5/6降至几乎为0。与全身应用阿片类药物相关的副作用，如恶心、呕吐和嗜睡，明显改善，她能够走到厕所。提示当疼痛部位局限于躯干时，仅使用局部麻醉药进行鞘内镇痛，不会影响下肢功能。
