PDF(Pubmed)
Abstract：
BACKGROUND: Intractable postherpetic neuralgia (PHN) can be difficult to manage even with aggressive multimodal therapies. Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system (IDDS). For craniofacial neuropathic pain, the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones, which may lead to insufficient analgesia.
METHODS: We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V (trigeminal nerve) distribution. The pain was rated 7-8 at rest and 9-10 at breakthrough pain (BTP) on a numeric rating scale. Despite receiving aggressive multimodal therapies including large doses of oral analgesics (gabapentin 150 mg q12 h, oxycodone 5 mg/acetaminophen 325 mg q6 h, and lidocaine 5% patch 700 mg q12 h) and sphenopalatine ganglion block, there was no relief of pain. Subsequently, the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern. The frequency of BTP episodes decreased. The patient\'s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later. He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.
CONCLUSIONS: The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.
METHODS: We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V (trigeminal nerve) distribution. The pain was rated 7-8 at rest and 9-10 at breakthrough pain (BTP) on a numeric rating scale. Despite receiving aggressive multimodal therapies including large doses of oral analgesics (gabapentin 150 mg q12 h, oxycodone 5 mg/acetaminophen 325 mg q6 h, and lidocaine 5% patch 700 mg q12 h) and sphenopalatine ganglion block, there was no relief of pain. Subsequently, the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern. The frequency of BTP episodes decreased. The patient\'s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later. He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.
CONCLUSIONS: The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.
摘要：
背景：即使采用积极的多模式治疗，难治性带状疱疹后遗神经痛（PHN）也难以控制。尽管进行了保守治疗，但仍经历不受控制的难治性颅骨PHN的患者可能会受益于鞘内给药系统（IDDS）。对于颅面神经性疼痛，传统的方法是将鞘内导管尖端放置在颅神经根进入区的下方，这可能导致镇痛不足。
方法：我们描述了一名69岁的男性，在颅神经V（三叉神经）分布的眼部出现水疱性皮疹后，有1年的PHN病史。在数字评定量表上，疼痛在休息时被评为7-8，在突破疼痛（BTP）时被评为9-10。尽管接受了积极的多模式治疗，包括大剂量的口服镇痛药（加巴喷丁150毫克q12小时，羟考酮5毫克/对乙酰氨基酚325毫克q6小时，和利多卡因5%贴剂700毫克q12小时)和蝶腭神经节阻滞，没有减轻疼痛。随后，患者选择了植入式IDDS，导管尖端放置在椎间池。BTP发作频率降低。随访3个月后将患者的连续日剂量调整为0.032mg/d，并在5个月后停止。在停止脑内氢吗啡酮后6个月和1年的门诊随访中，他没有报告疼痛或其他不适。
结论：通过IDDS使用椎间池鞘内输注低剂量氢吗啡酮可能对严重的颅面PHN有效。
方法：我们描述了一名69岁的男性，在颅神经V（三叉神经）分布的眼部出现水疱性皮疹后，有1年的PHN病史。在数字评定量表上，疼痛在休息时被评为7-8，在突破疼痛（BTP）时被评为9-10。尽管接受了积极的多模式治疗，包括大剂量的口服镇痛药（加巴喷丁150毫克q12小时，羟考酮5毫克/对乙酰氨基酚325毫克q6小时，和利多卡因5%贴剂700毫克q12小时)和蝶腭神经节阻滞，没有减轻疼痛。随后，患者选择了植入式IDDS，导管尖端放置在椎间池。BTP发作频率降低。随访3个月后将患者的连续日剂量调整为0.032mg/d，并在5个月后停止。在停止脑内氢吗啡酮后6个月和1年的门诊随访中，他没有报告疼痛或其他不适。
结论：通过IDDS使用椎间池鞘内输注低剂量氢吗啡酮可能对严重的颅面PHN有效。
