Fumić Dunkić Lidija, Kustura Antonia, Magdić Turković Tihana
Division of Anesthesiology, Intensive Care and Pain Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.
The Catholic University of Croatia, School of Medicine, Zagreb, Croatia.
Acta Clin Croat. 2023 Nov;62(Suppl4):77-81. doi: 10.20471/acc.2023.62.s4.11.
The indication for the application of invasive procedures in the therapy of cancer pain is lack of response to opioids or patients who have side effects to opioid therapy that significantly impair the quality of life. Invasive treatment of cancer pain should not be the last resort but should be an integrative part in the treatment of cancer pain in combination with opioid therapy as a part of multimodal therapy. For visceral pain, interventional techniques represent a minimally invasive and reliable option for many diagnoses where active treatment options have been exhausted. There is evidence for the effectiveness of the celiac plexus block in pain treatment for pancreatic cancer and some upper abdominal cancers. According to research, the hypogastric neurolytic block is an option for pelvic visceral pain treatment and has proven to be more effective than oral opioid pain treatment. Recently, progress has been made with intrathecal and epidural analgesia as safe and effective therapeutic options with a positive risk-benefit ratio for cancer pain treatment over a long period of time and in home settings. Invasive procedures are a safe and effective option for cancer pain therapy, thus significantly affecting the quality of life.
在癌症疼痛治疗中,应用侵入性治疗手段的指征是对阿片类药物无反应或对阿片类药物治疗有副作用且严重影响生活质量的患者。癌症疼痛的侵入性治疗不应是最后的手段,而应作为多模式治疗的一部分,与阿片类药物治疗相结合,成为癌症疼痛治疗的一个综合组成部分。对于内脏疼痛,在许多积极治疗方案都已用尽的诊断中,介入技术是一种微创且可靠的选择。有证据表明,腹腔神经丛阻滞在胰腺癌和一些上腹部癌症的疼痛治疗中是有效的。根据研究,下腹神经溶解阻滞是治疗盆腔内脏疼痛的一种选择,并且已被证明比口服阿片类药物止痛治疗更有效。最近,鞘内和硬膜外镇痛取得了进展,作为安全有效的治疗选择,在长期和家庭环境中对癌症疼痛治疗具有积极的风险效益比。侵入性治疗手段是癌症疼痛治疗的一种安全有效的选择,从而显著影响生活质量。