Ferrer-Brechner T
Pain Management Center, University of California, Los Angeles 90024.
Cancer. 1989 Jun 1;63(11 Suppl):2343-7. doi: 10.1002/1097-0142(19890601)63:11<2343::aid-cncr2820631145>3.0.co;2-c.
This review focuses on available anesthetic techniques for cancer patients, the indications, and appropriate agents for these potent tools in a stepwise approach to cancer pain. Anesthetic procedures are desirable when they will not compromise bodily functions important to the patient, and when tumor-directed therapy and noninvasive or less-invasive, low-risk approaches (primarily pharmacologic tailoring of analgesic drugs) fail to control pain. Nondestructive techniques include the epidural/intrathecal use of opioids via an implanted catheter, and local anesthetic blocks of nerves and sympathetic ganglia. Chronic intrathecal or epidural opioid infusion seems ideal if the life expectancy is 2 to 3 months. Local anesthetic blocks can help prognosticate results of subsequent neurolytic blocks, including undesirable effects. Destructive anesthetic procedures comprise injections of neurolytic agents (most commonly phenol or alcohol), and insertion of freezing probes, into nerves and ganglia. The types of nerve blocks performed, their complications, and success rates, and limitations of commonly used neurolytic agents as well as their proper applications, are described. The importance of proper patient selection and knowledge of the pathophysiology of the pain being treated is stressed, as is the appropriate timing of anesthetic procedures in the course of the disease.
本综述重点介绍了癌症患者可用的麻醉技术、适应症以及这些有效工具在逐步治疗癌症疼痛时所适用的药物。当麻醉程序不会损害对患者重要的身体功能，且肿瘤导向治疗以及非侵入性或微创、低风险方法（主要是镇痛药的药理学调整）无法控制疼痛时，麻醉程序是可取的。非破坏性技术包括通过植入导管进行硬膜外/鞘内使用阿片类药物，以及对神经和交感神经节进行局部麻醉阻滞。如果预期寿命为2至3个月，慢性鞘内或硬膜外阿片类药物输注似乎是理想的选择。局部麻醉阻滞有助于预测后续神经溶解阻滞的结果，包括不良影响。破坏性麻醉程序包括向神经和神经节注射神经溶解剂（最常见的是苯酚或酒精）以及插入冷冻探针。描述了所进行的神经阻滞类型、其并发症、成功率以及常用神经溶解剂的局限性及其正确应用。强调了正确选择患者以及了解所治疗疼痛的病理生理学的重要性，以及在疾病过程中麻醉程序的适当时间安排。
