【罂粟摘要】不可切除胰腺癌患者行神经毁损性内脏神经阻滞与患者疼痛缓解、生存率和生活质量的关系：一项随机对照试验
不可切除胰腺癌患者行神经毁损性内脏神经阻滞与患者疼痛缓解、生存率和生活质量的关系：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：任文鑫 编辑：佟睿 审校：曹莹
胰腺癌患者的癌痛临床上常用神经毁损内脏神经阻滞治疗。然而，它对胰腺癌患者生存和生活质量的影响仍有争议。作者的主要假设是，使用神经阻滞后，能够更好的缓解癌症疼痛。其次，他们假设使用镇痛剂患者的生存和生活质量会受到影响。
在中国的五个临床试验中心进行这项随机、双盲、平行对照试验。符合条件的中度至重度疼痛患者被随机分配接受无水乙醇组（神经毁损组）或生理盐水内脏神经阻滞组（对照组）。主要结果指标是用视觉模拟量表测量患者的疼痛缓解。记录阿片类药物的消耗量，患者的生存率、生活质量和不良反应。所有临床试验中心采用了统一的镇痛剂的管理方案。对患者进行了8个月或直至患者死亡的随访。
96名患者（每组48人）被纳入分析。与安慰剂注射相比，神经毁损组在头3个月的疼痛缓解程度更高（第一个月最大；均差为0.7[95%CI，0.3至1.0]；调整后的P < 0.001）。与安慰剂注射相比，前5个月神经毁损组的阿片类药物消耗量较低（第一个月最大；均差为95.8[95%CI，67.4-124.1]；校正后P<0.001）。组间生存率有明显差异（风险比为1.56[95%CI，1.03-2.35]；P=0.036）。第四阶段的患者发现神经毁损组生存率明显下降（风险比为1.94[95% CI，1.29-2.93]；P = 0.001），但第三阶段的患者没有（风险比，1.08[95% CI，0.59至1.97]；P = 0.809）。没有观察到生活质量的差异。
对于不能切除的胰腺癌患者，神经毁损内脏神经阻滞似乎是控制疼痛和减少阿片类药物需求的有效选择。
Daosong Dong, Mingfang Zhao, Jingmei Zhang, et al.Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial.Anesthesiology 2021; 135:686–98.
Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial
Background: Neurolytic splanchnic nerve block is used to manage pancreatic cancer pain. However, its impact on survival and quality of life remains controversial. The authors’ primary hypothesis was that pain relief would be better with a nerve block. Secondarily, they hypothesized that analgesic use, survival, and quality of life might be affected.
Methods: This randomized, double-blind, parallel-armed trial was conducted in five Chinese centers. Eligible patients suffering from moderate to severe pain conditions were randomly assigned to receive splanchnic nerve block with either absolute alcohol (neurolysis) or normal saline (control). The primary outcome was pain relief measured on a visual analogue scale. Opioid consumption, survival, quality of life, and adverse effects were also documented. Analgesics were managed using a protocol common to all centers. Patients were followed up for 8 months or until death.
Results: Ninety-six patients (48 for each group) were included in the analysis. Pain relief with neurolysis was greater for the first 3 months (largest at the first month; mean difference, 0.7 [95% CI, 0.3 to 1.0]; adjusted P < 0.001) compared with placebo injection. Opioid consumption with neurolysis was lower for the first 5 months (largest at the first month; mean difference, 95.8 [95% CI, 67.4 to 124.1]; adjusted P < 0.001) compared with placebo injection. There was a significant difference in survival (hazard ratio, 1.56 [95% CI, 1.03 to 2.35]; P = 0.036) between groups. A significant reduction in survival in neurolysis was found for stage IV patients (hazard ratio, 1.94 [95% CI, 1.29 to 2.93]; P = 0.001), but not for stage III patients (hazard ratio, 1.08 [95% CI, 0.59 to 1.97]; P = 0.809). No differences in quality of life were observed.
Conclusions: Neurolytic splanchnic nerve block appears to be an effective option for controlling pain and reducing opioid requirements in patients with unresectable pancreatic cancer.
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