摘要
癌末病人的疼痛，依照WHO所指示的三階段治療後，仍有2-10%的病人無法減緩疼痛。這些病人包括：具特殊疼痛症候群、無法承受嗎啡的副作用以及對嗎啡產生耐受性。對於這些病人，我們可以引進開刀房所使用的麻醉技術，作疼痛的緩解。並將此法納爲治療癌症疼痛的第四階段。我們報告一位胰臟癌末期的病人，因爲腹痛會診安寧共照做疼痛緩解，評估後其疼痛指數爲9-10分，使用皮下嗎啡注射一天後，病人意識不清、呼吸變慢，暫停嗎啡注射後，意識及呼吸次數回復正常，但疼痛又回復9-10分。在與家屬討論並會診麻醉科後，爲病人使用硬脊膜外嗎啡止痛法，之後疼痛指數降爲4-5分，意識清醒。病人及家屬對如此的疼痛都能接受，病人在15日之後安祥往生。
並列摘要
The majority of cancer patients with pain can be managed with drug therapy along the steps of the WHO analgesic ladder. However, 2-3% of patients have pain that does not respond to dose escalation of opioid. These patients are including with the particular pain syndrome, analgesic-related adverse effects, or tolerance. For these clinical settings, various interventional therapies are available, many of which are adapted from operating-room anaesthetic techniques. We present a case of terminal pancreatic cancer, received epidural morphine for intractable cancer pain. This 79 years old kind woman was admitted to internal department ward due to severe abdominal pain and dyspnea. Due to intractable pain she was consulted to us for pain management. After consultation, the pain score evaluated by visual analog score (VAS) is about 9-10. Then the prescription of subcutaneous morphine was given. Day after, the patient became conscious disturbance, and dyspnea. The patient's consciousness was restored after cessation of the prescription, and so did the breathing rate. By stopping the pain control, the VAS score returned to 9-10 again. After having discussed with her family, they all accepted the suggestion from Department of Anesthesia by administrating the morphine through epidural route. By using the epidural morphine, the VAS of the patient was kept within 4-5, with clear consciousness. Both the patient and family were so satisfied with this result. The patient passed away peacefully in 15 days later.
延伸閱讀
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