Ilias Wilfried, Todoroff Boris
Dept Anesthesiology, Intensive Care Medicine and Pain Therapy, Academic Teaching Hospital St. John of God, Vienna, Austria;
Med Devices (Auckl). 2008 Jul;1:41-7. doi: 10.2147/mder.s3623. Epub 2008 Oct 21.
Intrathecal therapy represents an effective and well established treatment of nonmalignant as well as malignant pain. Devices available include mechanical constant flow pumps as well as electronic variable flow pumps with patient-controlled bolus release. The latter provide faster dose finding, individual pain control, and good acceptance by patients. New technologies such as membrane pumps and rechargeable devices are expected to be developed to clinical perfection. The available drugs for intrathecal therapy are listed according to the polyanalgesic consensus on intrathecal therapy. The integration of remote patient-controlled analgesia into electronic implantable devices, and the peptide analgesic ziconotide, have significantly improved intrathecal therapy. Complications include infections, catheter ruptures or disconnections, catheter granulomas, and technical dysfunctions. Further possibilities for optimizing intrathecal therapy include development of new drugs, drug side effects, catheter and pump technologies, and surgical techniques.
鞘内治疗是一种治疗非恶性和恶性疼痛的有效且成熟的方法。可用的装置包括机械恒流泵以及具有患者自控推注释放功能的电子可变流泵。后者能更快地确定剂量、实现个体化疼痛控制，且患者接受度良好。预计诸如膜泵和可充电装置等新技术将发展至临床完善阶段。鞘内治疗可用药物是根据鞘内治疗的多模式镇痛共识列出的。将远程患者自控镇痛集成到电子植入式装置中，以及使用肽类镇痛药齐考诺肽，显著改善了鞘内治疗。并发症包括感染、导管破裂或断开、导管肉芽肿以及技术故障。优化鞘内治疗的其他可能性包括新药研发、药物副作用、导管和泵技术以及手术技术。
