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首页> 外文期刊>Journal of pain and symptom management. >Alternative treatments of breakthrough pain in patients receiving spinal analgesics for cancer pain.
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Alternative treatments of breakthrough pain in patients receiving spinal analgesics for cancer pain.

机译：接受脊柱镇痛药治疗癌症疼痛的患者的突破性疼痛替代疗法。

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Patients who experience a poor response to different systemic opioid trials (oral and intravenous) are candidates for spinal treatment. Breakthrough pain occurring in this group of patients is challenging for physicians. This phenomenon has never been described in this context and the treatment is quite difficult, as patients already demonstrated a poor response to systemic opioids. We report a preliminary experience of alternative methods, including the intrathecal injection of local anesthetic boluses as needed, or alternatively, the use of sublingual ketamine. Twelve consecutive patients with advanced cancer and pain were selected for intrathecal treatment after receiving different trials with systemic opioids. During intrathecal therapy, pain flares not responding to high doses of intravenous morphine were treated with intrathecal boluses of local anesthetics titrated to achieve the best balance between analgesia and adverse effects, or with sublingual ketamine (25 mg), according to their preference. Pain and symptoms were recorded for each episode of breakthrough pain during hospital admission. Effective pain control was achieved in all the episodes treated within 10 minutes with either method, without relevant complications. A mean volume of 0.6 mL of levobupivacaine (LB) 0.25% (1.5 mg) was effective within a few minutes and was well tolerated in patients receiving a continuous intrathecal infusion of a combination of morphine and LB in different doses. Similarly, ketamine in doses of 25 mg sublingually was effective and relatively well tolerated. Despite the difficult clinical situation of these patients, these approaches controlled almost all breakthrough pain events previously unresponsive to relatively high doses of intravenous opioids. These intensive treatments should be reserved for a very selected population and initiated in an appropriate setting with frequent monitoring facilities and skilled nursing.
机译：对各种全身阿片类药物试验（口服和静脉注射）反应较差的患者可进行脊柱治疗。在这组患者中发生的突破性疼痛对医生而言具有挑战性。这种现象从未在这种情况下被描述过，并且治疗非常困难，因为患者已经显示出对全身阿片类药物的不良反应。我们报告了替代方法的初步经验，包括鞘内注射局部麻醉药或根据需要使用舌下氯胺酮。在接受系统性阿片类药物的不同试验后，连续选择十二名患有晚期癌症和疼痛的患者进行鞘内治疗。在鞘内治疗期间，对鞘内注射局部麻醉药进行大剂量滴定以达到镇痛和不良反应之间的最佳平衡，或对舌下氯胺酮（25毫克）治疗，对高剂量静脉内吗啡无反应的疼痛发作或舌下氯胺酮（25毫克）进行治疗。住院期间每次发作性疼痛记录疼痛和症状。使用任何一种方法在10分钟内治疗的所有发作均实现了有效的疼痛控制，且无相关并发症。平均体积为0.6 mL的0.25％左旋布比卡因（LB）（1.5 mg）在几分钟内有效，并且在接受鞘内连续注入不同剂量的吗啡和LB的患者中耐受性良好。类似地，舌下25 mg的氯胺酮是有效的并且耐受性相对较好。尽管这些患者的临床情况很困难，但这些方法控制了几乎所有以前对较高剂量的静脉阿片类药物无反应的突破性疼痛事件。这些强化治疗应留给非常选定的人群，并在适当的环境下进行，并应配备频繁的监测设施和熟练的护理人员。

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