Department of Anaesthesiology and Intensive Care Medicine/Pain Centre, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.
Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Scand J Pain. 2024 Oct 4;24(1). doi: 10.1515/sjpain-2024-0041. eCollection 2024 Jan 1.
Two-thirds of patients with advanced cancer experience pain. Some of these patients have severe pain refractory to oral and parenteral medication, for whom intrathecal pain treatment could be an option. While intrathecal therapy is presently used with good results in clinical practice, the current evidence is limited. Hence, increased knowledge of intrathecal pain treatment is needed. This retrospective study aimed to assess complications and side effects related to intrathecal pain treatment in patients with terminal cancer.
A retrospective study on all patients who received intrathecal treatment with morphine and bupivacaine through externalized catheters for cancer-related pain at a single university hospital during a 5-year period.
Treatment-related complications were reported in 24 out of 53 patients. The most common complications were catheter dislocation (13%), catheter occlusion (9%), falls due to bupivacaine-related numbness or weakness (9%), and reversible respiratory depression (8%). There were five serious complications, i.e., meningitis or neurological impairment, of which four were reversible. Side effects related to intrathecal drugs, or the implantation procedure were observed in 35 patients. The most common were bupivacaine-related numbness or weakness (57%) and reversible post-dural puncture headache (19%). Systemic opioid doses decreased during the first 3 weeks of intrathecal treatment, from a median daily dose of 681 to 319 oral morphine milligram equivalents. The median treatment duration time was 62 days.
Complications related to intrathecal treatment are common, but mostly minor and reversible. Side effects are predominantly related to unwanted pharmacological effects from intrathecal drugs. Intrathecal treatment enables the reduction of systemic opioid doses, which indicates a good treatment effect on pain. Hence, intrathecal therapy can be considered a safe pain-relieving treatment in patients with severe refractory cancer-related pain. Future research is warranted on patient acceptability and satisfaction of intrathecal pain treatment.
三分之二的晚期癌症患者会经历疼痛。其中一些患者的疼痛严重，无法通过口服和静脉药物治疗缓解，对于这些患者，鞘内疼痛治疗可能是一种选择。虽然鞘内治疗目前在临床实践中取得了良好的效果，但现有证据有限。因此，需要增加对鞘内疼痛治疗的了解。本回顾性研究旨在评估终末期癌症患者接受鞘内吗啡和布比卡因治疗的并发症和副作用。
回顾性分析了在一家大学医院接受外置导管鞘内治疗的 53 例癌症相关疼痛患者的资料，研究时间为 5 年。
24 例（45.3%）患者出现与治疗相关的并发症。最常见的并发症是导管脱位（13%）、导管阻塞（9%）、因布比卡因引起的麻木或无力导致跌倒（9%）和可逆转的呼吸抑制（8%）。有 5 例严重并发症，即脑膜炎或神经功能障碍，其中 4 例是可逆的。35 例（66.0%）患者出现与鞘内药物或植入过程相关的副作用。最常见的是布比卡因引起的麻木或无力（57%）和可逆转的硬脊膜穿剌后头痛（19%）。鞘内治疗开始后的前 3 周，系统阿片类药物剂量从 681 中位数每日吗啡毫克当量降至 319。中位治疗持续时间为 62 天。
鞘内治疗相关的并发症常见，但大多是轻微且可逆转的。副作用主要与鞘内药物的意外药理作用有关。鞘内治疗可减少系统阿片类药物剂量，表明对疼痛有较好的治疗效果。因此，鞘内治疗可被认为是治疗严重难治性癌痛的一种安全的止痛治疗方法。需要进一步研究鞘内疼痛治疗的患者接受程度和满意度。
