Perruchoud Christophe, Cachemaille Matthieu
Clinique de la douleur, Hôpital de la Tour, 1217 Meyrin/Genève.
Centre d'antalgie, Service d'anesthésiologie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne.
Rev Med Suisse. 2022 Jun 22;18(787):1254-1258. doi: 10.53738/REVMED.2022.18.787.1254.
Intrathecal drug delivery appeared in the early eighties and allows to administer high concentrate analgesic medications in the cerebrospinal fluid with higher efficacy and a limited incidence of systemic side effects. Opioids are still the first line treatment with high-quality evidence for chronic cancer pain, and limited evidence for chronic non-cancer pain, being often considered as a last resort therapy. Device implantation requires a strict patient's selection with a close follow-up in order to adapt therapy, refill the reservoir and detect and prevent potential severe complications.
鞘内药物递送始于八十年代初,可将高浓度镇痛药物注入脑脊液,疗效更高且全身副作用发生率有限。阿片类药物仍是慢性癌痛高质量证据的一线治疗药物,而慢性非癌痛的证据有限,常被视为最后手段的治疗方法。器械植入需要严格筛选患者并密切随访,以便调整治疗、补充储药器以及检测和预防潜在的严重并发症。