Gordon R L
School of Pharmacy, University of the Pacific, San Diego, CA, USA.
Ann Pharmacother. 1998 Feb;32(2):193-6. doi: 10.1345/aph.17205.
To report the case of a prolonged intravenous ketorolac continuous infusion given via a central line in a cancer patient with intractable bone pain.
A 56-year-old Hispanic man with stage IV non-small-cell lung cancer and multiple bone metastases was admitted to the hospital for intractable pain inadequately controlled at home by conventional therapy. He was treated with an intravenous continuous infusion of ketorolac 120 mg in 250 mL of NaCl 0.9% infused over 24 hours. The ketorolac was given via a central line for 14 days in addition to fentanyl patient-controlled analgesia. Over this time period the patient reported his pain to be well controlled. His requests for bolus doses of fentanyl decreased dramatically and the dose of the continuous intravenous fentanyl was reduced by 22%. In addition, the total daily dose of ketorolac was reduced following a change from intermittent bolus dosing to a continuous infusion.
The management of cancer pain secondary to bone metastasis is a difficult and challenging problem frequently encountered by the healthcare team. The use of nonsteroidal antiinflammatory drugs (NSAIDs) as adjuvant therapy is a common practice. However, many terminally ill patients are unable to take oral medications, thus limiting NSAID treatment options. Ketorolac tromethamine is approved by the Food and Drug Administration (FDA) as a parenteral NSAID. As with other NSAIDs, the risk of adverse drug reactions must be considered when using this class of medication. The FDA has approved ketorolac for the short-term (< or = 5 d) management of moderately severe acute pain that requires analgesia at the opioid level, usually in the postoperative setting. However, certain patients may benefit from long-term use exceeding the FDA-recommended guidelines of 5 days of maximum therapy.
A prolonged central intravenous ketorolac continuous infusion was successful in treating a cancer patient with intractable bone pain secondary to widely metastatic non-small-cell lung cancer.
报告1例癌症患者因顽固性骨痛通过中心静脉导管长期静脉持续输注酮咯酸的病例。
一名56岁的西班牙裔男性，患有IV期非小细胞肺癌并多发骨转移，因在家中常规治疗无法充分控制的顽固性疼痛入院。他接受了静脉持续输注酮咯酸，120mg溶于250mL 0.9%氯化钠溶液中，24小时内输注完毕。除芬太尼患者自控镇痛外，酮咯酸通过中心静脉导管给药14天。在此期间，患者报告疼痛得到良好控制。他对芬太尼推注剂量的需求大幅减少，静脉持续输注芬太尼的剂量减少了22%。此外，从间歇性推注给药改为持续输注后，酮咯酸的每日总剂量也有所减少。
骨转移继发癌症疼痛的管理是医疗团队经常遇到的一个困难且具有挑战性的问题。使用非甾体抗炎药（NSAIDs）作为辅助治疗是一种常见做法。然而，许多晚期患者无法口服药物，从而限制了NSAIDs的治疗选择。酮咯酸氨丁三醇已被美国食品药品监督管理局（FDA）批准为胃肠外NSAIDs。与其他NSAIDs一样，使用这类药物时必须考虑药物不良反应的风险。FDA已批准酮咯酸用于短期（≤5天）管理中度至重度急性疼痛，这种疼痛通常在术后需要阿片类水平的镇痛。然而，某些患者可能受益于超过FDA推荐的5天最大治疗指南的长期使用。
长期中心静脉持续输注酮咯酸成功治疗了一名因广泛转移的非小细胞肺癌继发顽固性骨痛的癌症患者。
