The Polyanalgesic Consensus Conference (PACC): Recommendations for Intrathecal Drug Delivery: Guidance for Improving Safety and Mitigating Risks

被引：98

作者：

Deer, Timothy R. ^{[1
]}

Pope, Jason E. ^{[2
]}

Hayek, Salim M. ^{[3
]}

Lamer, Tim J. ^{[4
]}

Veizi, Ilir Elias ^{[5
]}

Erdek, Michael ^{[6
]}

Wallace, Mark S. ^{[7
]}

Grider, Jay S. ^{[8
]}

Levy, Robert M. ^{[9
]}

Prager, Joshua ^{[10
]}

Rosen, Steven M. ^{[11
]}

Saulino, Michael ^{[12
]}

Yaksh, Tony L. ^{[13
]}

De Andres, Jose A. ^{[14
]}

Abejon Gonzalez, David ^{[15
]}

Vesper, Jan ^{[16
]}

Schu, Stefan ^{[17
]}

Simpson, Brian ^{[18
]}

Mekhail, Nagy ^{[19
]}

机构：

[1] Ctr Pain Relief, Charleston, WV USA

[2] Summit Pain Alliance, Santa Rosa, CA USA

[3] Case Western Reserve Univ, Univ Hosp, Cleveland Med Ctr, Cleveland, OH 44106 USA

[4] Mayo Clin, Rochester, MN USA

[5] Case Western Reserve Univ, Vet Adm Med Ctr, Cleveland, OH 44106 USA

[6] Johns Hopkins Univ, Sch Med, Anesthesiol & Crit Care Med, Baltimore, MD USA

[7] Univ Calif San Diego, Dept Anesthesia, San Diego, CA USA

[8] Univ Kentucky, Coll Med, UK HealthCare Pain Serv, Lexington, KY USA

[9] Marcus Neurosci Inst, Boca Raton, FL USA

[10] CRPS, UCLA Med Plaza, Los Angeles, CA USA

[11] Fox Chase Pain Management Associates PC, Doylestown, PA USA

[12] MossRehab, Elkins Pk, PA USA

[13] Univ Calif San Diego, Anesthesiol & Pharmacol, San Diego, CA 92103 USA

[14] Hosp Gen Univ, Valencia Sch Med, Valencia, Spain

[15] Hosp Univ Quiron Madrid, Madrid, Spain

[16] Univ Klinikum Dusseldorf, Neurochirurg Klin, Dusseldorf, Germany

[17] Sana Kliniken, Duisburg, Germany

[18] Univ Wales Hosp, Dept Neurosurg, Cardiff, S Glam, Wales

[19] Cleveland Clin, Cleveland, OH 44106 USA

来源：

NEUROMODULATION | 2017年 / 20卷 / 02期

关键词：

Bupivacaine; chronic pain; clonidine; fixed rate pump; intrathecal drug delivery; intrathecal granuloma; neuropathic pain; nonmalignant pain; opioid; programmable pump; safety; ziconotide; CATHETER-TIP GRANULOMAS; SPINAL-CORD COMPRESSION; CHRONIC NONCANCER PAIN; INFLAMMATORY MASS; REGIONAL-ANESTHESIA; NONMALIGNANT PAIN; INFUSION SYSTEMS; MORPHINE-SULFATE; DEVICE INFECTION; REFRACTORY PAIN;

D O I：

10.1111/ner.12579

中图分类号：

R-3 [医学研究方法]; R3 [基础医学];

学科分类号：

1001 ;

摘要：

Introduction: Intrathecal therapy is an important part of the pain treatment algorithm for chronic disease states. The use of this option is a viable treatment strategy, but it is inherent for pain physicians to understand risk assessment and mitigation. In this manuscript, we explore evidence and mitigating strategies to improve safety with intrathecal therapy. Methods: A robust literature search was performed covering January 2011 to October 9, 2016, in PubMed, Embase, MEDLINE, Biomed Central, Google Scholar, Current Contents Connect, and International Pharmaceutical Abstracts. The information was cross-referenced and compiled for evidence, analysis, and consensus review, with the intent to offer weighted recommendations and consensus statements on safety for targeted intrathecal therapy delivery. Results: The Polyanalgesic Consensus Conference has made several best practice recommendations to improve care and reduce morbidity and mortality associated with intrathecal therapy through all phases of management. The United States Prevention Service Task Force evidence level and consensus strength assessments are offered for each recommendation. Conclusion: Intrathecal therapy is a viable and relatively safe option for the treatment of cancer-and noncancer-related pain. Continued research and expert opinion are required to improve our current pharmacokinetic and pharmacodynamic model of intrathecal drug delivery, as this will undoubtedly improve safety and efficacy.

引用

页码：155 / 176

页数：22

共 170 条

[1] Spinal granuloma in a patient receiving a spinal infusion of morphine and clonidine [J].