Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Ann Acad Med Singap. 2009 Nov;38(11):943-6.
Cancer pain is one of the most frequently encountered pain syndromes. With the application of the World Health Organization analgesic ladder, adequate analgesia is achieved in 75% to 90% of patients. The remaining patients suffer from intractable pain requiring intrathecal analgesia. The aim of this study was to retrospectively analyse the pain intensity before and after intrathecal analgesia and review the complications associated with the implantation and the care of the intrathecal device.
We reviewed medical records of all cancer patients whose pain were managed by intrathecal catheter implants in our centre from February 2005 to August 2008. The pain intensity, medication and complications related to intrathecal catheter insertion or drug delivery were reviewed at the time before starting the intrathecal analgesia (T0) and time of discharge from the hospital/time prior to death during their stay in the hospital (Tdsc).
Twenty-nine patients were included. Out of these 29 patients, 86.2% had metastatic cancer. The most common indication was poor pain control. Pain intensity was reduced significantly at the time of discharge from hospital (P < 0.001). The number of patients with side effects from opioids decreased after intrathecal treatment. We found 4 patients with short-term catheter complications e.g. kinked or displaced catheter and catheter-related infection.
Intractable cancer pain could be managed effectively by intrathecal analgesia with a significant decrease in pain intensity and reduced opioid-related side effects. The side effects due to intrathecal opioids and complications from intrathecal catheter were minimal.
癌症疼痛是最常见的疼痛综合征之一。通过应用世界卫生组织的镇痛阶梯，75%至 90%的患者可获得充分的镇痛。其余患者则患有需要鞘内镇痛的难治性疼痛。本研究旨在回顾性分析鞘内镇痛前后的疼痛强度，并回顾与鞘内装置植入和护理相关的并发症。
我们回顾了 2005 年 2 月至 2008 年 8 月期间在我们中心接受鞘内导管植入治疗的所有癌症患者的病历。在开始鞘内镇痛之前（T0）和住院期间出院时/死亡前的时间（Tdsc），我们评估了疼痛强度、药物以及与鞘内导管插入或药物输送相关的并发症。
共纳入 29 例患者。其中 86.2%的患者患有转移性癌症。最常见的适应症是疼痛控制不佳。出院时疼痛强度明显减轻（P < 0.001）。鞘内治疗后，阿片类药物副作用的患者数量减少。我们发现 4 例患者出现短期导管并发症，如导管扭结或移位以及导管相关性感染。
鞘内镇痛可有效治疗难治性癌症疼痛，显著降低疼痛强度，并减少阿片类药物相关的副作用。鞘内阿片类药物的副作用和鞘内导管的并发症很小。
