Cramond T, Stuart G
Pain Relief Service, Royal Brisbane Hospital, Australia.
J Pain Symptom Manage. 1993 Oct;8(7):465-73. doi: 10.1016/0885-3924(93)90189-3.
Among the most difficult pain management problems are those associated with advanced head and neck cancer, and those in which pain is midline, bilateral, or diffuse. The authors report effective control of intractable pain in 52 patients by injection of small doses of morphine via an Ommaya or a Cordis reservoir into the lateral cerebral ventricle. The technique is safe and effective. The reservoir is usually inserted under local analgesia so the method of pain relief is available to patients in whom general anesthesia would be difficult or contraindicated. The doses of morphine required to maintain analgesia remain remarkably low. Tolerance reported by other authors has not been a problem when preoperative assessment of the patient has been thorough. Maximum survival time has been 75 wk and another patient has lived 65 wk. Complications included two colonized reservoirs, one dislodged ventricular catheter, three blocked catheters, and one postoperative meningitis. For patients with diffuse midline or bilateral pain, or intractable pain associated with advanced head and neck cancer, the use of intraventricular morphine should be considered when satisfactory pain relief is not achieved with oral morphine or continuous subcutaneous infusion.
最难处理的疼痛管理问题之一是与晚期头颈癌相关的问题，以及疼痛位于中线、双侧或呈弥漫性的情况。作者报告通过经奥马亚（Ommaya）或科迪斯（Cordis）储液器向侧脑室注射小剂量吗啡，有效控制了52例患者的顽固性疼痛。该技术安全有效。储液器通常在局部麻醉下插入，因此对于难以进行全身麻醉或存在全身麻醉禁忌的患者，这种缓解疼痛的方法是可行的。维持镇痛所需的吗啡剂量一直非常低。当对患者进行了全面的术前评估时，其他作者所报告的耐受性问题并未出现。最长生存时间为75周，另有一名患者存活了65周。并发症包括两个储液器定植、一个脑室导管移位、三个导管堵塞和一例术后脑膜炎。对于弥漫性中线或双侧疼痛患者，或与晚期头颈癌相关的顽固性疼痛患者，当口服吗啡或持续皮下输注无法实现满意的疼痛缓解时，应考虑使用脑室内吗啡。
