Department of Anesthesiology, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital-General Campus, 501 Smyth Rd., CCW 1551, Ottawa, ON, K1H 8L6, Canada.
Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Drugs. 2015 Nov;75(17):1957-80. doi: 10.1007/s40265-015-0471-1.
The intrathecal drug-delivery system (IDDS) is one mode of infusing analgesic medications directly into the cerebrospinal fluid in close proximity to their site of action. This modality has been employed in patients with refractory pain either due to malignant or non-malignant causes for over 30 years. Unfortunately, and despite the number of years it has been in use, there is still a scarcity of rigorous evidence to guide its integration into clinical practice. Current best evidence is inconclusive as to the comparative effectiveness and harms of the IDDS relative to routine medical care of patients. There are far more systematic reviews than high-quality primary comparative studies of the IDDS vs. conventional pain treatment. Existing clinical practice recommendations are best viewed as expert opinion with competing interests. This article will review the existing literature for indications, contraindications, consensus statements, different technologies, and complications of the IDDS. Although approved analgesics for IDDS delivery are limited to morphine and ziconotide, many other analgesics, alone or in combination, are routinely used in this setting. This review will also focus on the pharmacology, clinical efficacy, and safety of intrathecal medications extensively used in clinical practice; including agents approved, unapproved, and under development.
鞘内药物递送系统（IDDS）是将镇痛药物直接输注到靠近作用部位的脑脊液中的一种方式。这种方式已经在患有难治性疼痛的患者中使用了超过 30 年，无论是由于恶性还是非恶性原因引起的疼痛。不幸的是，尽管它已经使用了多年，但仍然缺乏严格的证据来指导其纳入临床实践。目前的最佳证据对于 IDDS 相对于常规医疗护理患者的相对有效性和危害尚无定论。与 IDDS 与常规疼痛治疗的高质量对照研究相比，系统评价要多得多。现有的临床实践建议最好被视为存在利益冲突的专家意见。本文将回顾 IDDS 的适应症、禁忌症、共识声明、不同技术和并发症的现有文献。尽管 IDDS 输送的批准镇痛药物仅限于吗啡和齐考诺肽，但许多其他镇痛药物，单独或联合使用，在这种情况下也经常使用。本综述还将重点介绍在临床实践中广泛使用的鞘内药物的药理学、临床疗效和安全性，包括已批准、未批准和正在开发的药物。
