Menon Mahesh, Taha Nafisa, Purohit Navita, Kothari Vatsal, Singh Shweta
Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Department of Critical Care Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Indian J Palliat Care. 2016 Oct-Dec;22(4):507-510. doi: 10.4103/0973-1075.191860.
Metastatic spinal cord compression is a devastating complication of cancer. Patients may often require high doses of opioids that may cause side effects, myoclonus being one such. A 63-year-old male suffering from malignant spinal cord compression was admitted to our institution. The primary team managed him conservatively with pharmacotherapy with no relief of pain, and he experienced myoclonus and sedation as adverse effects. A continuous cervical epidural catheter with local anesthetic infusion was inserted for 5 days to control his pain. This relieved his pain, which was sustained even after we removed the epidural catheter on day 5, for up to 64 days until the time of his death. Continuous cervical epidural local anesthetic infusions may help with refractory pain by deafferentation of noxious stimuli. Central neuraxial blocks may be a valuable rescue in selected patients.
转移性脊髓压迫是癌症的一种毁灭性并发症。患者通常可能需要高剂量的阿片类药物，而这些药物可能会引起副作用，肌阵挛就是其中之一。一名63岁患有恶性脊髓压迫的男性被收治到我们机构。初级治疗团队对他进行了保守的药物治疗，但疼痛并未缓解，并且他出现了肌阵挛和镇静等不良反应。插入一根持续输注局部麻醉药的颈段硬膜外导管，持续5天以控制他的疼痛。这缓解了他的疼痛，即使在第5天我们拔除硬膜外导管后，疼痛仍持续缓解了长达64天，直至他去世。持续的颈段硬膜外局部麻醉药输注可能通过消除有害刺激的传入来帮助缓解难治性疼痛。在特定患者中，中枢神经轴阻滞可能是一种有价值的挽救措施。
