BACKGROUND Patients with craniofacial cancer frequently suffer from severe pain. The traditional intrathecal, oral, or intravenous analgesics could only provide insufficient pain relief with many side effects. Thus, a more effective analgesia approach is required. This study aimed to investigate the safety and efficacy of placing the catheter of an intrathecal morphine pump in the prepontine cistern for the treatment of craniofacial cancer pain. METHODS We performed a retrospective study of patients with primary or metastatic craniofacial cancer pain who received the catheter placement of an intrathecal morphine pump into the prepontine cistern in eleven medical centers from September 2019 to December 2023. Friedman test and pairwise signed-rank test were used to evaluate the difference in numeric rating scale (NRS) scores, the number of breakthrough pain episodes, dose of intrathecal morphine, and dose of systemic morphine equivalents (oral, patch, intravenous) from preoperative period to postoperative days 1, 7, and 30. P values were corrected for multiple comparisons using Bonferroni test. RESULTS The study included 33 patients. The median (interquartile range [IQR]) of NRS scores at days 1, 7, and 30 postimplant were 2.0 (1.0-3.5), 2.0 (1.0-2.0), and 1.0 (1.0-2.0), respectively, which was significantly lower than that before surgery (median, 8.0; IQR, 7.0-10.0; all P < .001). Compared to baseline number/d of breakthrough pain episodes (median, 6.0; IQR, 4.5-10.0), there was a progressive decrease in the number/d of breakthrough pain episodes at day 1, day 7, and day 30 postimplant, and the median (IQR) were 1.0 (0.0-3.0), 2.0 (0.0-3.0), and 0.0 (0.0-1.2), respectively (all P < .001). Approximately 78.8% and 96.7% of patients reported pain relief >50% at days 1 and 30 postimplant, respectively. Compared with that at day 1 postimplant, the proportion of patients with a pain relief rate >75% at day 30 postimplant also increased with continued intrathecal treatment. Compared to the dose of baseline systemic morphine equivalents (median, 228 mg.d-1; IQR, 120-408 mg.d-1), the dose of systemic morphine equivalents reduced significantly from 0(0-120) mg.d-1 at day 1 postimplant (P = .001), to 0 (0-0) mg.d-1 at days 7 and 30 postimplant (both P < .001). Few patients reported perioperative adverse events, including nausea, constipation, hypotension, urinary retention, dry mouth, headache, and sedation. No severe adverse events occurred. CONCLUSIONS Placing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events. This procedure could be considered in patients with severe refractory craniofacial cancer pain.

中文翻译：

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脑桥前池鞘内给药系统治疗顽固性颅面癌疼痛患者：一项多中心回顾性研究。


背景技术患有颅面癌的患者经常遭受剧烈疼痛。传统的鞘内、口服或静脉注射镇痛药只能提供足够的疼痛缓解效果，并且有许多副作用。因此，需要更有效的镇痛方法。本研究旨在探讨将鞘内吗啡泵导管置于脑桥前池治疗颅面癌疼痛的安全性和有效性。方法 我们对 2019 年 9 月至 2023 年 12 月期间在 11 个医疗中心接受鞘内吗啡泵置入脑桥前池的原发性或转移性颅面癌疼痛患者进行回顾性研究。采用弗里德曼检验和配对符号秩检验评估从术前到术后第 1、7 和 30 天数值评定量表 (NRS) 评分、突发性疼痛发作次数、鞘内吗啡剂量和全身吗啡当量剂量（口服、贴剂、静脉注射）的差异使用 Bonferroni 检验对 P 值进行多重比较校正。结果 该研究包括 33 名患者。植入后第 1 天、第 7 天和第 30 天的 NRS 评分中位数（四分位距 [IQR]）分别为 2.0 (1.0-3.5)、2.0 (1.0-2.0) 和 1.0 (1.0-2.0)，显着较低高于手术前（中位数，8.0；IQR，7.0-10.0；所有 P < .001）。与基线每天爆发性疼痛发作的次数（中位数，6.0；IQR，4.5-10.0）相比，植入后第 1 天、第 7 天和第 30 天，每天爆发性疼痛发作的次数逐渐减少，并且中位数 (IQR) 分别为 1.0 (0.0-3.0)、2.0 (0.0-3.0) 和 0.0 (0.0-1.2)（所有 P < .001）。大约78.8%和96。7% 的患者报告在植入后第 1 天和第 30 天疼痛分别缓解了 >50%。与植入后第1天相比，植入后第30天疼痛缓解率>75%的患者比例也随着持续鞘内治疗而增加。与基线全身吗啡当量剂量（中位数，228 mg.d-1；IQR，120-408 mg.d-1）相比，全身吗啡当量剂量从0（0-120）mg.d-1显着降低植入后第 1 天为 1 (P = .001)，植入后第 7 天和第 30 天为 0 (0-0) mg.d-1（P < .001）。很少有患者报告围手术期不良事件，包括恶心、便秘、低血压、尿潴留、口干、头痛和镇静。没有发生严重不良事件。结论 将鞘内吗啡泵的导管尖端放入脑桥前池可有效缓解难治性颅面癌疼痛，且吗啡总剂量需求极低，不良事件少。对于患有严重难治性颅面癌疼痛的患者可以考虑该手术。