Sufentanil citrate and morphine/bupivacaine as alternative agents in chronic epidural infusions for intractable non-cancer pain.
Sufentanil citrate and morphine/bupivacaine as alternative agents in chronic epidural infusions for intractable non-cancer pain.
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柠檬酸舒芬太尼和吗啡/布比卡因作为慢性硬膜外输注治疗顽固性非癌性疼痛的替代药物。
DOI：
10.1097/00006123-199107000-00013
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发表时间：
1991
期刊：
影响因子：
4.8
通讯作者：
Mary Beth Boland
中科院分区：
文献类型：
--
作者：
S. Hassenbusch;M. Stanton‐Hicks;J. Soukup;E. Covington;Mary Beth Boland
椎管内麻醉（通常是鞘内吗啡）植入泵输注越来越多地用于非癌症引起的难治性慢性疼痛患者。对一些病人来说，注射吗啡很难控制疼痛。7例诊断为蛛网膜炎，硬膜外瘢痕，和/或椎体压缩性骨折的患者在硬膜外途径的替代方案治疗。为了获得最大的灵活性，美敦力将可编程输液泵与导管植入T6-T10，并通过言语疼痛量表监测疼痛。在3例患者中，硬膜外输注0.5%布比卡因（MS-MARC）中的吗啡，疼痛几乎没有缓解，而且没有明显的副作用（如头痛、恶心或呕吐）。在这些患者中，硬膜外输注枸橼酸舒芬太尼分别使疼痛减轻92%、82%和40%，且无副作用。另外四名患者发现，从最初的枸橼酸舒芬太尼输注改为MS-MARC后，疼痛缓解效果更明显。这些患者的疼痛程度减轻（无副作用）分别为92%、76%、59%和47%。枸橼酸舒芬太尼的镇痛和最小的副作用理论上是由于其较高的亲脂性促进局部经硬膜扩散到脊髓和限制向上扩散到脑干。枸橼酸舒芬太尼对于可编程泵也是有利的，因为它的效力是吗啡的100倍，因此允许更长的泵补充时间和更高的注射剂量。虽然这项研究是在有限数量的患者中进行的，但使用可编程输注泵对非癌症患者硬膜外输注枸橼酸舒芬太尼和MS-MARC提供了重要的替代药物组合和途径。
Intraspinal narcotic (usually intrathecal morphine) infusions with implanted pumps are increasingly used in patients with intractable chronic pain not caused by cancer. In some patients, pain control is difficult with infusions of morphine. Seven patients with diagnoses of arachnoiditis, epidural scarring, and/or vertebral body compression fracture were treated with alternative solutions in an epidural route. For maximal flexibility, Medtronic implanted programmable infusion pumps with catheters to T6-T10 were used, and pain was monitored by verbal pain scales. In three patients, epidural infusions of morphine in 0.5% bupivacaine (MS-MARC) resulted in little or no pain relief without significant side effects (e.g., headache, nausea, or vomiting). In these same patients, epidural infusions of sufentanil citrate resulted in pain scale reductions of 92%, 82%, and 40%, respectively, with no side effects. Four other patients found more effective pain relief when switched from initial sufentanil citrate infusions to MS-MARC. Pain scale reductions (with no side effects) were 92%, 76%, 59%, and 47% in these patients. Pain relief and minimal side effects with sufentanil citrate is theorized to result from its higher lipophilicity promoting local transdural diffusion to spinal cord and limiting upward diffusion to the brain stem. Sufentanil citrate is also advantageous for programmable pumps because it is 100 times more potent than morphine and therefore allows longer pump refill times and higher infusion doses. Although this study was done on a limited number of patients, sufentanil citrate and MS-MARC in epidural infusions using programmable infusion pumps for non-cancer patients provide significant alternative drug combinations and routes.