Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
Acta Clin Croat. 2022 Sep;61(Suppl 2):109-114. doi: 10.20471/acc.2022.61.s2.14.
In 10% to 30% cancer-pain cases standard analgesic therapy fails to provide effective pain relief. Interventional techniques, such as peripheral nerve blocks, neuraxial analgesia along with neurolytic blocks may be used for such refractory pain. Peripheral nerve blocks can be used when pain occurs in the territory of one or more peripheral nerves, but rarely as main therapy. Neuraxial analgesia is a valid option for progressive cancer pain, and healthcare possibilities and costs call into question the utility of intrathecal infusion pumps. Neurolysis is the targeted destruction of a nerve or nerve plexus, using chemicals, radiofrequency ablation (RFA), cryoablation, and neurosurgical procedures; however, it rarely completely eliminates pain because patients frequently experience coexisting somatic and neuropathic pain as well. Complex conditions of palliative patients along with limited high-quality randomized controlled trials limit the use of interventional procedures. Even so, some cancer patients benefit from interventional procedures to achieve pain alleviation and consequently improve quality of life.
在 10% 至 30% 的癌痛病例中，标准的镇痛疗法无法提供有效的疼痛缓解。介入技术，如外周神经阻滞、脊柱内镇痛以及神经溶解阻滞，可用于治疗此类难治性疼痛。当疼痛发生在一个或多个周围神经的区域时，可以使用外周神经阻滞，但很少作为主要治疗方法。脊柱内镇痛是进展性癌痛的有效选择，但医疗保健的可能性和成本质疑了鞘内输注泵的实用性。神经溶解是使用化学物质、射频消融 (RFA)、冷冻消融和神经外科手术来靶向破坏神经或神经丛；然而，由于患者经常经历共存的躯体和神经性疼痛，因此它很少能完全消除疼痛。姑息治疗患者的复杂情况以及有限的高质量随机对照试验限制了介入性手术的应用。即便如此，一些癌症患者还是受益于介入性手术来缓解疼痛，从而提高生活质量。
