癌症疼痛管理中的脊柱镇痛-MASCC一般实践建议
Sebastiano Mercadante1, Kenneth Candido2, Peter Staats3
1La Maddalena Cancer Center, Palermo, Italy. terapiadeldolore@lamaddalenanet.it.
概括
脊柱镇痛可以在常规方法失败时为癌症患者提供有效的疼痛缓解. 专家建议使用植入式药物输送系统进行内 (IT) 治疗,优化阿片类药物和局部麻醉剂的使用,以获得更好的结果.
科学领域:
- 疼痛管理 疼痛管理
- 在瘤学瘤学.
- 神经外科 神经外科
背景情况:
- 抗常规治疗的癌症疼痛带来了重大挑战.
- 脊柱疼痛缓解,特别是内 (IT) 药物输送,为管理耐火性癌症疼痛提供了一个替代方案.
- 需要专家的共识来指导脊柱药物输送的临床实践.
研究的目的:
- 为癌症相关疼痛的脊柱药物输送提供临床实践建议.
- 突出用于止痛的内途径的好处和考虑因素.
- 提供关于阿片类药物选择,剂量和辅助疗法的指导.
主要方法:
- 专家小组由MASSC召开,以制定临床实践建议.
- 对内药物输送系统 (ITDD) 的证据和专家意见的审查.
- 讨论阿片类药物选择 (吗啡,水合吗啡),局部麻醉剂和锡科诺提德.
主要成果:
- 内输送允许最小的止痛剂量具有显著的效果和较少的副作用.
- 建议使用吗啡和水利吗啡是IT类阿片类药物;当局部麻醉剂在最佳位置时提供协同效应.
- 建议在先前治疗的基础上将口服吗啡转换为IT吗啡的转换比率 (100: 1 至 300: 1).
- 水友性阿片类药物的球体可能不足以治疗突破性疼痛;共享决策至关重要.
结论:
- 通过ITDD进行脊柱镇痛是耐火性癌症疼痛的可行选择.
- 仔细选择止痛药,适当的剂量策略和导管放置对于疗效至关重要.
- 考虑个体患者因素的共同决策对于成功的干预性疼痛管理至关重要.
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