Dr. Sun, Department of Orthopedics, General Hospital of the PLA Airforce, Beijing, China. Liu, Yang, Zhao, Lu, Anesthesia and Operation Center, Department of Anesthesiology, Chinese PLA General Hospital, Beijing, China. Wang, Department of Emergency, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), China. Dai, Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), China. Cheng, Jin, Department of Anesthesiology, Pain Medicine Center Jinling Hospital, Nanjing, China. Dong, Wang, Song, Department of Pain medicine, The First Affiliated Hospital of Chinese Medical University, China. Sun, Department of Neurology, Xijing Hospital, The Fourth Military Medical University (Air Force Medical University), China. Kaye, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Prof. Sun, Department of Comprehensive treatment, the second Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China.
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):48-66.
For patients suffering from primary or metastatic cancer above the middle thoracic vertebrae, refractory pain management still remains a great challenge. Theoretically, inserting a catheter tip into the cisterna magna may be a promising solution. However, at present, there have been no reliable data regarding this novel technique. We therefore investigated the efficacy and safety of an advanced approach for pain relief in a specific population.
Thirty participants from two hospitals received the intrathecal deliveries of opioid to either one of two sites: cisterna magna (n = 15) or lower thoracic region (n = 15). Pain relief (visual analogue scale, VAS), quality of life (short form (36) health survey, SF-36) as well as depression (self-rating depression scale, SDS) were assessed in the follow-up visits and compared between the two groups.
Patients receiving intrathecal morphine delivery to cisterna magna achieved greater pain improvement indicated as significant decrease of VAS scores at day 1 and 7, and achieved better improvement in physical function (day 7 and 30), role physical (day 7 and 30), body pain (day 7, 30 and 90), general health (day 7, 30 and 90), vitality (day 7, 30 and 90), social function (day 90), role emotional (day 7 and 90), mental health (day 7, 30 and 90) and SDS (day 1 and 7).
Intrathecal morphine delivery to cisterna magna might be an effective and safe technique for patients suffering from cancer at the middle thoracic vertebrae or above to control refractory pain. Trial registration: No. ChiCTR-ONN-17010681.
对于中胸段以上原发性或转移性癌症患者，难治性疼痛管理仍然是一个巨大的挑战。从理论上讲，将导管尖端插入脊髓蛛网膜下腔可能是一种有前途的解决方案。然而，目前，关于这种新技术还没有可靠的数据。因此，我们针对特定人群，调查了一种缓解疼痛的先进方法的疗效和安全性。
来自两家医院的 30 名参与者接受了阿片类药物鞘内给药，分别给药于两个部位之一：脊髓蛛网膜下腔（n = 15）或下胸段（n = 15）。在随访中评估了疼痛缓解（视觉模拟评分，VAS）、生活质量（简明健康调查问卷，SF-36）以及抑郁（自评抑郁量表，SDS），并比较了两组之间的差异。
接受鞘内吗啡输注至脊髓蛛网膜下腔的患者疼痛改善更为明显，表现为 VAS 评分在第 1 天和第 7 天显著下降，并且在第 7 天和第 30 天的身体功能、角色身体、身体疼痛、一般健康、活力、社会功能、角色情感、心理健康和 SDS 方面均有更好的改善。
鞘内吗啡输注至脊髓蛛网膜下腔可能是一种治疗中胸段或以上癌症患者难治性疼痛的有效且安全的技术。
ChiCTR-ONN-17010681。
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