Intrathecal morphine for chronic benign pain.
Intrathecal morphine for chronic benign pain.
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DOI：
10.1016/s1521-6896(03)00014-4
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发表时间：
2003-09-01
期刊：
影响因子：
--
通讯作者：
Gerber, Helmut R
中科院分区：
文献类型：
--
作者：
Gerber, Helmut R
在慢性良性疼痛的治疗中，鞘内阿片类药物的给药产生有效的镇痛作用，而不干扰下肢的运动和感觉功能。只有当常规口服和全身给药的疼痛控制不充分或与难以控制的副作用相关时，才应考虑鞘内阿片类药物。在植入永久性器械之前，必须进行试验期和心理评估。约40%的患者因各种并发症需要手术翻修。荷尔蒙的变化可能会影响性行为。导管肉芽肿可以形成高浓度的吗啡。如布比卡因，可乐定和氯胺酮的辅助药物可能是必要的，以处理吗啡耐受的发展。目前鞘内注射技术的先进性远远超过了我们对这种治疗方式潜在神经学影响的认识。
In the treatment of chronic benign pain, the administration of an intrathecal opioid produces a potent analgesia without interfering with the motor and sensory functions of the lower extremities. An intrathecal opioid should be considered only when pain control with conventional oral and systemic administration is inadequate or is associated with unmanageable side effects. A trial period and a psychological evaluation are mandatory prior to implantation of a permanent device. About 40% of the patients need surgical revision for various complications. Hormonal changes may influence sexual behaviour. Catheter granulomas can form with high concentrations of morphine. Adjuvant drugs such as bupivacaine, clonidine and ketamine might be necessary to deal with the development of tolerance to morphine. The sophistication of available technology for intrathecal infusion today far exceeds our knowledge of the potential neurological effects of this treatment modality.