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Der Schmerz

, Volume 9, Issue 6, pp 305–311 | Cite as

Hochdosierte intrathekale Clonidingabe in der Behandlung neuropathischer Tumorschmerzen

2 Fallberichte
  • D. Zech
  • R. Sabatowski
  • L. Badbruch
  • S. Grond
Schmerzforum
  • 12 Downloads

Zusammenfassung

Es wird über 2 Patienten mit tumorbedingten perinealen Schmerzen durch ein rezidiviertes Rektumkarzinom berichtet. In beiden Fällen standen anfänglich Nozizeptorschmerzen im Vordergrund, die sich durch eine kontinuierliche rückenmarknahe Morphingabe beherrschen ließen. Die Größenzunahme des Tumorrezidivs mit Infiltration des Spinalkanals bzw. Teildestruktion des Plexus lumbosacralis führten zu einer Schmerzexazerbation mit dem Auftreten von Deafferenzierungs-schmerzen. Durch den rückenmarknahen Einsatz von clonidin wurde Schmerzfreiheit erzielt. Zur Aufrechterhaltung der Analgesie mußte die Clonidindosierung im Therapieverlauf stufenweise auf Tagesdosierungen von 1,31 bzw. 1,46 mg erhöht werden. In der Präterminalphase war zur Symptomkontrolle zusätzlicher Dyspnoe eine ergänzende systemische Morphingabe erforderlich. Die Behandlung mit rückenmarknahem Opioid und Clonidin konnte intermittierend ambulant durchgeführt werden. Bradykardien und arterielle Hypotonien, die zu Beginn der kontinuierlichen Clonidinzufuhr und nach Dosissteigerungen auftraten, ließen sich durch die Gabe von Parasympathikolytika und Vasopressoren beherrschen.

Schlüsselwörter

Clonidin Deafferenzierungsschmerz Morphin Toleranzentwicklung Tumorschmerz 

High-dose intrathecal clonidine in the treatment of neuropathic tumor pain. Two case reports

Abstract

Two cases with perineal pain caused by recurrent carcinoma of the rectum are reported. Initially both patients suffered from predominantly nociceptive pain, which was treated adequately with spinal opioids. Tumor growth with epidural spread and infiltration of the plexus lumbosacralis caused severe neuropathic pain. Both patients were free of pain with a combination of spinal clonidine and opioids. Clonidine doses had to be increased up to 1.31 and 1.46 mg daily in order to provide adequate analgesia. Outpatient treatment was possible for several weeks with stable dosage. Bradycardia and hypotension occurred with initial dose titration and after dose increases and were treated with parasympathicolytic drugs and vasopressor agents. Both patients were given spinal clonidine until their death 4 1/2 and 4 months later. In the final stages, adjuvant systemic administration of morphine was necessary to control dyspnea.

Key words

Clonidine cancer pain Deafferentation pain Development of tolerance Morphine 

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Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • D. Zech
    • 1
  • R. Sabatowski
    • 1
  • L. Badbruch
    • 1
  • S. Grond
    • 1
  1. 1.Klinik für Anaesthesiologie und Operative IntensivmedizinUniversität zu KölnKöln

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