Brogan Shane E, Sindt Jill E, Odell Daniel W, Gulati Amitabh, Dupoiron Denis
Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA
Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah, USA.
Reg Anesth Pain Med. 2023 Jun;48(6):319-325. doi: 10.1136/rapm-2022-103770. Epub 2022 Aug 17.
Pain and suffering related to cancer are challenging issues that continue to deserve consideration for treatment optimization. Advances in analgesic management and control of the underlying cancer have improved symptom management, yet many patients still suffer from uncontrolled pain. Intrathecal drug delivery has an established role in the management of refractory cancer pain, but there are significant knowledge gaps in our understanding and application of this therapy. This review addresses several areas of controversy, including the importance of intrathecal catheter tip location, the necessity of an intrathecal trial and the role of intrathecal ziconotide and local anesthetics. In each area, the evidence is discussed, with an emphasis on presenting practical clinical guidance and highlighting deficiencies in our knowledge that are worthy of future investigation.
与癌症相关的疼痛和痛苦是具有挑战性的问题，仍值得继续关注以优化治疗。镇痛管理和对潜在癌症的控制方面的进展改善了症状管理，但许多患者仍遭受疼痛控制不佳之苦。鞘内药物递送在难治性癌症疼痛的管理中已确立了作用，但我们对该疗法的理解和应用存在重大知识空白。本综述探讨了几个有争议的领域，包括鞘内导管尖端位置的重要性、鞘内试验的必要性以及鞘内齐考诺肽和局部麻醉剂的作用。在每个领域，都对证据进行了讨论，重点是提供实用的临床指导并突出我们知识中的不足，这些不足值得未来研究。
