Sato Chiyo, Okabe Tadashi, Nakanishi Kazuhiro, Sakamoto Atsuhiro
Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2010 Dec;77(6):333-7. doi: 10.1272/jnms.77.333.
Titration of oral or intravenous medication is the preferred method of pain management for most patients with cancer pain. However, some patients experience insufficient pain relief or considerable adverse effects from systemic opioids. For these reasons, the control of severe cancer pain continues to present a variety of challenges to clinicians. We report our experience of successfully managing cancer pain in a patient by means of long-term intrathecal administration of morphine, bupivacaine, and racemic ketamine via a patient-controlled delivery system. This therapy reduced the patient's nausea, vomiting, and somnolence, led to early hospital discharge, and increased her level of daily activity. There were no signs of motor paralysis, psychomimetic alteration, neurological dysfunction, or infection related to the intrathecal route during treatment. Intrathecal therapy is an effective treatment in terminally ill patients.
对于大多数癌症疼痛患者而言，口服或静脉用药滴定法是疼痛管理的首选方法。然而，一些患者使用全身性阿片类药物后疼痛缓解不足或出现相当多的不良反应。由于这些原因，重度癌症疼痛的控制仍然给临床医生带来各种挑战。我们报告了通过患者自控给药系统长期鞘内注射吗啡、布比卡因和消旋氯胺酮成功管理一名患者癌症疼痛的经验。该疗法减轻了患者的恶心、呕吐和嗜睡症状，使患者提前出院，并提高了她的日常活动水平。治疗期间未出现与鞘内途径相关的运动麻痹、拟精神病性改变、神经功能障碍或感染迹象。鞘内治疗对晚期患者是一种有效的治疗方法。
