Main Regional Center for Pain Relief & Supportive Care, La Maddalena Cancer Center , Palermo , Italy.
Department of Anaesthesiology, Advocate Illinois Masonic Medical Center , Chicago , USA.
Expert Rev Anticancer Ther. 2019 Aug;19(8):697-703. doi: 10.1080/14737140.2019.1643240. Epub 2019 Jul 18.
: There is a growing recognition of the role of interventional techniques (IT) for the management of cancer pain (CP). However, there are many controversies on how and when to use such techniques. : Patients who are unresponsive to systemic opioid analgesics or patients unable to tolerate systemic opioids may benefit from different IT for which the successful use depends on the selection of the right therapy for the right patient. The evidence regarding these techniques is often anecdotal and the potential risks, benefits, alternatives, and complications should be balanced to take a decision. : The successful use of IT depends on many factors, including a careful assessment of previous treatments, patient's characteristics, and the logistics. Risks, benefits, alternatives, and complications should be balanced to take a decision. Although IT have been described as effective in patients with CP, the evidence is still limited, unless for celiac plexus block, which has a high benefit-risk ratio. The intrathecal therapy should be chosen in patients who were poorly responding to opioid therapy, after an appropriate trial with different opioids. A careful selection of patients and techniques, a large experience in performing the procedures, sufficient logistics and staff skills, appropriate indications, and assessment of benefits and risks may help to achieve the best benefit for patients in individual cases.
: 人们越来越认识到介入技术（IT）在癌症疼痛（CP）管理中的作用。然而，对于如何以及何时使用这些技术，存在许多争议。: 对全身阿片类镇痛药无反应或不能耐受全身阿片类药物的患者可能受益于不同的 IT，其成功使用取决于为合适的患者选择合适的治疗方法。这些技术的证据往往是轶事证据，应权衡潜在风险、益处、替代方案和并发症，以做出决策。: IT 的成功使用取决于许多因素，包括对先前治疗、患者特征和后勤的仔细评估。应权衡风险、益处、替代方案和并发症，以做出决策。尽管 IT 已被描述为对 CP 患者有效，但证据仍然有限，除非对腹腔神经丛阻滞，其具有较高的获益风险比。鞘内治疗应在对阿片类药物治疗反应不佳的患者中选择，在适当的阿片类药物试验后。仔细选择患者和技术、在执行程序方面具有丰富的经验、充足的后勤和人员技能、适当的适应症以及对益处和风险的评估，可能有助于在个别情况下为患者实现最佳获益。
