Hassenbusch S J, Pillay P K, Magdinec M, Currie K, Bay J W, Covington E C, Tomaszewski M Z
Department of Neurosurgery, Cleveland Clinic Foundation, Ohio.
J Neurosurg. 1990 Sep;73(3):405-9. doi: 10.3171/jns.1990.73.3.0405.
In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief. A multidisciplinary team (neurosurgeon, anesthesiologists, psychiatrists, oncologists, and nurse clinicians) evaluated and treated all of the patients studied. Percutaneous placement of temporary epidural catheters for a trial assessment was performed by the anesthesiologists. Pain evaluations were conducted independently by psychiatrists using both verbal and visual analog scales. From 1982 to 1988, 41 (59.4%) of 69 patients evaluated for eligibility experienced good pain control during trial assessment and were subsequently implanted with Infusaid infusion pumps. Preinfusion pain analog values were 8.6 +/- 0.3 and postimplantation values at 1 month were 3.8 +/- 0.4 (p less than 0.001). Over this same 1-month period. requirements of systemic morphine equivalents decreased by 79.3% with epidural infusions as compared to preinfusion requirements (p less than 0.001). There were no instances of epidural scarring, respiratory depression, epidural infections, meningitis, or catheter blockage. One patient developed apparent drug tolerance and three patients required further catheter manipulations. This series strongly suggests that significant reductions in cancer pain can be obtained with few complications and a low morphine tolerance rate using chronic epidural morphine infusion. Anesthesiology and psychiatry input, along with temporary catheter infusion screening and quantitative pain evaluations using analog scales, are essential.
过去，使用麻醉剂输注来控制慢性疼痛综合征主要是通过鞘内（蛛网膜下腔）途径进行的。本报告介绍了首批大量晚期癌症患者中采用植入式泵和硬膜外脊髓导管进行持续硬膜外吗啡输注治疗顽固性疼痛的情况。该研究的目的是证明硬膜外途径有效且并发症最少，并且通过临时硬膜外导管输注进行筛查能使后续疼痛缓解率很高。一个多学科团队（神经外科医生、麻醉师、精神科医生、肿瘤学家和护士临床医生）对所有研究患者进行评估和治疗。麻醉师通过经皮放置临时硬膜外导管进行试验性评估。疼痛评估由精神科医生独立使用言语和视觉模拟量表进行。从1982年到1988年，69名接受资格评估的患者中有41名（59.4%）在试验评估期间疼痛得到良好控制，随后植入了英福赛德输注泵。输注前疼痛模拟值为8.6±0.3，植入后1个月的值为3.8±0.4（p<0.001）。在同一1个月期间，与输注前相比，硬膜外输注时全身吗啡等效物的需求量减少了79.3%（p<0.001）。没有硬膜外瘢痕形成、呼吸抑制、硬膜外感染、脑膜炎或导管堵塞的情况。1名患者出现明显的药物耐受性，3名患者需要进一步进行导管操作。该系列研究有力地表明，使用慢性硬膜外吗啡输注可在并发症少且吗啡耐受性低的情况下显著减轻癌症疼痛。麻醉学和精神病学的参与，以及临时导管输注筛查和使用模拟量表进行定量疼痛评估至关重要。
