Bulat Evgeny, Chaturvedi Rahul, Johnson Peyton, Rakesh Neal, Gulati Amitabh
Pain Treatment Specialists, VIP Medical Group, New York, NY, USA.
Department of Anesthesiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.
J Pain Res. 2025 Mar 21;18:1503-1509. doi: 10.2147/JPR.S504556. eCollection 2025.
Compared to conventional medical management, targeted drug delivery provides superior cancer pain management with fewer side-effects and potentially improved survival. Intrathecal (IT) clonidine has been used off-label to improve analgesia in patients with cancer pain, but evidence regarding safe dosing in this patient population is limited. This study evaluates the impact of adding IT clonidine on pain, opioid consumption, and the prevalence of medication-related side-effects. It also provides initial dosing recommendations for cancer pain.
This was a retrospective chart review conducted at a single academic cancer center. Medical records between 2012 and 2022 were queried for patients who had an intrathecal pump (ITP). Patients' charts were reviewed prior to starting IT clonidine, at the IT clonidine start date, at 1-3 months follow-up, and at over three months follow-up. Primary outcomes included the visual analog scale (VAS) score and daily systemic morphine milligram equivalents (MME). Secondary outcomes included IT or systemic medication side-effects and the daily doses of concurrent IT opioids and local anesthetic (LA).
Eighteen patients were included. No significant change in VAS or systemic MME was observed at follow-up after starting IT clonidine. Median daily IT bupivacaine and opioids with or without patient-controlled boluses significantly rose by the first follow-up; by the second follow-up, only IT opioids were elevated. There was a trend towards a lower prevalence of medication-related side-effects across follow-up periods. On post-hoc logistic regression analysis, IT clonidine dosing was the sole significant predictor of side-effect prevalence. Higher IT clonidine dosing was associated with a lower likelihood of side-effects. Initial IT clonidine doses of 40-60 mcg/day were associated with a 50-75% reduced probability of side-effects.
While its role in reducing pain and systemic opioids is complex, IT clonidine may have a beneficial role in mitigating medication-related side-effects from systemic opioids, IT opioids, or LA for cancer pain. IT clonidine may be safely initiated at doses of 40-60 mcg/day for this indication.
与传统药物治疗相比，靶向给药在癌症疼痛管理方面具有优势，副作用更少，且可能提高生存率。鞘内注射可乐定已被用于改善癌症疼痛患者的镇痛效果，但关于该患者群体安全剂量的证据有限。本研究评估添加鞘内注射可乐定对疼痛、阿片类药物用量及药物相关副作用发生率的影响。同时还给出了癌症疼痛的初始给药建议。
这是在一家学术性癌症中心进行的回顾性病历审查。查询了2012年至2022年间使用鞘内泵（ITP）患者的病历。在开始鞘内注射可乐定之前、鞘内注射可乐定开始日期、1至3个月随访时以及3个月以上随访时对患者病历进行审查。主要结局指标包括视觉模拟量表（VAS）评分和每日全身吗啡毫克当量（MME）。次要结局指标包括鞘内或全身用药的副作用以及同时使用的鞘内阿片类药物和局部麻醉药（LA）的每日剂量。
纳入18例患者。开始鞘内注射可乐定后的随访中，未观察到VAS或全身MME有显著变化。第一次随访时，无论有无患者自控推注，鞘内布比卡因和阿片类药物的每日中位数显著升高；到第二次随访时，仅鞘内阿片类药物升高。在整个随访期间，药物相关副作用的发生率有降低趋势。在事后逻辑回归分析中，鞘内注射可乐定的剂量是副作用发生率的唯一显著预测因素。鞘内注射可乐定剂量越高，副作用发生的可能性越低。初始鞘内注射可乐定剂量为40 - 60微克/天与副作用发生概率降低50 - 75%相关。
虽然鞘内注射可乐定在减轻疼痛和全身阿片类药物用量方面的作用较为复杂，但它可能在减轻全身阿片类药物、鞘内阿片类药物或局部麻醉药治疗癌症疼痛时的药物相关副作用方面发挥有益作用。针对这一适应症，鞘内注射可乐定可安全地以40 - 60微克/天的剂量开始使用。
