Vercauteren M P, Coppejans H, Adriaensen H A
Dept of Anesthesiology, University Hospital Antwerp, Edegem, Belgium.
Acta Anaesthesiol Belg. 1994;45(3):99-105.
Pain associated with chronic pancreatitis in particular is one of the most difficult and challenging syndromes that are presented to pain centers. Narcotic addiction is a common feature in this population. In this contribution an overview will be provided of the most pain treatment modalities based upon recent developments in the field of physiopathology, surgery, medical imaging and locoregional anesthetic techniques. Based upon personal experience it becomes progressively more clear that the most efficient alternative is not offered via neurolysis of the coeliac plexus. A shortlasting cure of 7-10 days with local anesthetics, injected via a coeliac plexus- or interpleural catheter may offer comparable but better reproducible durations of analgesia. Addition of corticosteroids during celiac plexus anesthesia may have additional benefits. Despite the progress in the field of internal medicine and surgery, a permanent solution is still far away for these patients.
尤其是与慢性胰腺炎相关的疼痛，是疼痛中心所面临的最困难且最具挑战性的综合征之一。阿片类药物成瘾在这一群体中很常见。本文将基于生理病理学、外科手术、医学成像和局部麻醉技术领域的最新进展，对最常用的疼痛治疗方式进行概述。根据个人经验，越来越明显的是，最有效的替代方法并非通过腹腔神经丛神经溶解术。通过腹腔神经丛或肋间导管注射局部麻醉药可实现7至10天的短期治愈，可能会提供相当但更可重复的镇痛时长。在腹腔神经丛麻醉期间添加皮质类固醇可能会有额外益处。尽管在内科和外科领域取得了进展，但对于这些患者来说，永久性的解决方案仍很遥远。
