Safety and Efficacy of Surgical Implantation of Intrathecal Drug Delivery Pumps in Patients With Cancer With Refractory Pain.

Autor:	Winston GM; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Zimering JH; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA.; Current affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York , New York , USA., Newman CW; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Reiner AS; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Manalil N; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Kharas N; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Gulati A; Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Rakesh N; Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Laufer I; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA.; Current affiliation: Department of Neurosurgery, NYU Langone Health, New York , New York , USA., Bilsky MH; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA., Barzilai O; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , New York , USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 May 03. Date of Electronic Publication: 2024 May 03.
DOI:	10.1227/neu.0000000000002978
Abstrakt:	Background and Objectives: Pain management in patients with cancer is a critical issue in oncology palliative care as clinicians aim to enhance quality of life and mitigate suffering. Most patients with cancer experience cancer-related pain, and 30%-40% of patients experience intractable pain despite maximal medical therapy. Intrathecal pain pumps (ITPs) have emerged as an option for achieving pain control in patients with cancer. Owing to the potential benefits of ITPs, we sought to study the long-term outcomes of this form of pain management at a cancer center. Methods: We retrospectively reviewed medical records of all adult patients with cancer who underwent ITP placement at a tertiary comprehensive cancer center between 2013 and 2021. Baseline characteristics, preoperative and postoperative pain control, and postoperative complication rate data were collected. Results: A total of 193 patients were included. We found that the average Numerical Rating Scale (NRS) score decreased significantly by 4.08 points (SD = 2.13, P < .01), from an average NRS of 7.38 (SD = 1.64) to an average NRS of 3.27 (SD = 1.66). Of 185 patients with preoperative and follow-up NRS pain scores, all but 9 experienced a decrease in NRS (95.1%). The median overall survival from time of pump placement was 3.62 months (95% CI: 2.73-4.54). A total of 42 adverse events in 33 patients were reported during the study period. The 1-year cumulative incidence of any complication was 15.6% (95% CI: 10.9%-21.1%) and for severe complication was 5.7% (95% CI: 3.0%-9.7%). Eleven patients required reoperation during the study period, with a 1-year cumulative incidence of 4.2% (95% CI: 2.0%-7.7%). Conclusion: Our study demonstrates that ITP implantation for the treatment of cancer-related pain is a safe and effective method of pain palliation with a low complication rate. Future prospective studies are required to determine the optimal timing of ITP implantation. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
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