Zusammenfassung
Bei schwer behandelbaren Krebsschmerzen, die auch unter Ausschöpfung aller enteralen und/oder transdermalen Optionen des WHO-Stufenschemas nicht oder nur mit inakzeptablen Nebenwirkungen (Kress 2009) beherrschbar sind, stellen intravenöse, subkutane und vor allem rückenmarknahe Applikationswege gute und erfolgversprechende Alternativen dar (Ballantyne und Carwood 2005; Burton et al. 2004; Cools et al. 1996; Dahm et al. 1998; Deer et al. 2012, 2017a, b; Eisenach et al. 1995; Nitescu et al. 1991; Vissers et al. 2011). Hierzu stehen neben externen, druckbetriebenen Einmalreservoirpumpen, vor allem externe, mikroprozessorgesteuerte, programmierbare patientenkontrollierte Pumpen (PCA-Pumpen), implantierbare Portsysteme für intravenösen, epiduralen oder intrathekalen Zugang sowie vollständig implantierbare gas- oder batteriebetriebene Pumpen (ausschließlich zur Intrathekalgabe) verschiedener Hersteller zur Verfügung. Insgesamt bleiben diese invasiven Verfahren wenigen Patienten vorbehalten und werden – abhängig von der Spezialisierung der jeweiligen Einrichtung – nur bei ca. 5–10 % der Tumorschmerzbehandlungen notwendig.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Literatur
Aldrete JA (1995) Epidural fibrosis after permanent catheter insertion and infusion. J Pain Symptom Manag 10:624–631
Ballantyne JC, Carwood CM (2005) Comparative efficacy of epidural, subarachnoid, and intracerebroventricular opioids in patients with pain due to cancer. Cochrane Database Syst Rev (1):CD005178
Burton AW et al (2004) Epidural and intrathecal analgesia is effective in treating refractory cancer pain. Pain Med 5:239–247
Coffey RJ, Burchiel K (2002) Inflammatory mass lesions associated with intrathecal drug infusion catheters: report and observations on 41 patients. Neurosurgery 50:78–86
Cools HJ, Berkhout AM, De Bock GH (1996) Subcutaneous morphine infusion by syringe driver for terminally ill patients. Age Ageing 25:206–208
Dahm P, Nitescu P, Appelgren L, Curelaru I (1998) Efficacy and technical complications of long-term continuous intraspinal infusions of opioid and/or bupivacaine in refractory nonmalignant pain: a comparison between the epidural and the intrathecal approach with externalized or implanted catheters and infusion pumps. Clin J Pain 14:4–16
Deer TR et al (2012) Polyanalgesic Consensus Conference – 2012: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 15:436–466
Deer TR et al (2017a) The Polyanalgesic Consensus Conference (PACC): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation 20(2):96–132
Deer TR et al (2017b) The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation 20(2):155–176
Devulder J, Ghys L, Dhondt W, Rolly G (1994) Spinal analgesia in terminal care: risk versus benefit. J Pain Symptom Manag 9:75–81
Drexel H et al (1989) Treatment of severe cacer pain by low-dose continuous subcutaneous morphine. Pain 36:169–176
Eisenach JC, Rauck RL, Buzzanell C, Lysak SZ (1989) Epidural clonidine analgesia for intractable cancer pain: phase I. Anesthesiology 71:647–652
Eisenach JC et al (1995) Epidural clonidine analgesia for intractable cancer pain. Pain 61:391–399
Hassenbusch S et al (2002) Management of intrathecal catheter-tip inflammatory masses: a consensus statement. Pain Med 3:313–323
Hogan Q et al (1991) Epidural opiates and local anesthetics for the management of cancer pain. Pain 46:271–279
Iida H et al (2001) The differential effects of stereoisomers of ropivacaine and bupivacaine on cerebral pial arterioles in dogs. Anesth Analg 93(6):1552–1556
Krames ES (1993) Intrathecal infusional therapies for intractable pain: patient management guidelines. J Pain Symptom Manag 8:36–46
Kress HG (2009) Unmet needs in drug treatment of chronic severe pain – clinical evidence on current and future concepts. Eur J Pain 13(Suppl 1):11–15
Kress HG et al (2009) Intrathecal therapy: what has changed with the introduction of ziconotide. Pain Pract 9:338–347
Lanning RM, Hrushesky WJM (1990) Cost comparison of wearable and implantable drug delivery systems. Proc ASCO 9:322
McMillan MR, Doud T, Nugent W (2003) Catheter-associated masses in patients receiving intrathecal analgesic therapy. Anesth Analg 96:186–190
Müller H (2001) Spinale Opioidanalgesie. In: Zenz M, Jurna I (Hrsg) Lehrbuch der Schmerztherapie. Wissenschaftliche Verlagsges, Stuttgart, S 441–445
Nitescu P et al (1991) Long-term, open catheterization of the spinal subarachnoid space for continuous infusion of narcotic and bupivacaine in patients with „refractory“ cancer pain. Clin J Pain 7:143–161
O’Brien T et al (2017) European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain 21:3–19
Samuelsson H, Malmberg F, Eriksson M, Hedner T (1995) Outcomes of epidural morphine treatment in cancer pain: nine years of clinical experience. J Pain Symptom Manag 10:105–112
Sator-Katzenschlager S, Deusch E, Maier P, Spacek A, Kress HG (2001) The long-term antinociceptive effect of intrathecal S(+)-ketamine in a patient with established morphine tolerance. Anesth Analg 93:1032–1034
Sjoberg M, Nitescu P, Appelgren L, Curelaru I (1994) Long-term intrathecal morphine and bupivacaine in patients with refractory cancer pain. Anesthesiology 80:284–297
Smith DE (1990) Spinal opioids in the home and hospice setting. J Pain Symptom Manag 5:175–182
Vissers KCP et al (2011) Evidence-based interventional pain medicine according to clinical diagnosis: 23. Pain in patients with cancer. Pain Pract 11:453–475
Vranken JH, Troost D, Wegener JT, Kruis MR, van der Vegt MH (2005) Neuropathological findings after continuous intrathecal administration of S(+)-ketamine for the management of neuropathic cancer pain. Pain 117(1–2):813–818
Waldmann CS, Eason JR, Rambohul E, Hanson GC (1984) Serum morphine levels. A comparison between continuous subcutaneous infusion and continuous intravenous infusion in postoperative patients. Anaesthesia 39:768–771
Yaksh TL (1996) In: Campbell JN (Hrsg) Pain 1996 – an updated reviewIntrathecal and epidural opiates: a review. IASP Press, Seattle, S 381–393
Yaksh TL et al (2002) Inflammatory masses associated with intrathecal drug infusion: a review of preclinical evidence and human data. Pain Med 3:300–31229
Yaksh TL et al (2003) Chronically infused intrathecal morphine in dogs. Anesthesiology 99:174–187
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 Der/die Autor(en), exklusiv lizenziert an Springer-Verlag GmbH, DE, ein Teil von Springer Nature
About this chapter
Cite this chapter
Kress, HG., Kraft, B. (2023). Systemische und rückenmarknahe Therapie mittels Schmerzpumpen und Ports. In: Bernatzky, G., Sittl, R., Likar, R. (eds) Schmerzbehandlung in der Palliativmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-64329-7_18
Download citation
DOI: https://doi.org/10.1007/978-3-662-64329-7_18
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-64328-0
Online ISBN: 978-3-662-64329-7
eBook Packages: Medicine (German Language)