Analysis of efficacy of intrathecal infusion of hydromorphone and its combination with ketamine and gabapentin in the treatment of refractory cancer pain
Objective To investigate the difference in the efficacy of continuous intrathecal infusion of morphine,hydro-morphone,and their combination with ketamine and gabapentin in the treatment of refractory cancer pain in patients with na-sopharyngeal cancer.Methods Late-stage nasopharyngeal cancer patients with refractory cancer pain treated at the First Hos-pital of Hohhot from January 2022 to June 2022 were selected and randomized into four groups.The M group received a con-tinuous intrathecal infusion of morphine.The HM group underwent continuous intrathecal infusion of hydromorphone.The HM+KET group received continuous intrathecal infusion of hydromorphone in combination with intravenous infusion of ket-amine.The HM+KET+GBP drug group underwent continuous intrathecal infusion of hydromorphone in combination with intra-venous infusion of ketamine and oral administration of gabapentin.The patients'numeric rating scale(NRS)pain scores,fre-quency of explosive cancer pain episodes in 24 hours,Pittsburgh sleep quality index(PSQI)scores,and survival status were recorded and compared.Results A total of 204 patients were enrolled,with 149 males(73.0%)and 55 females(27.0%),with an average age of(45.8±9.91)years old.Among them,there were 101 cases in the M group,34 cases in the HM group,34 cases in the HM+KET group,and 35 cases in the HM+KET+GBP group.The clinical symptoms,blood parameters,and pathological types of patients in each group were compared,and the differences were not statistically significant(P>0.05).Before treatment,there was no statistically significant difference in NRS score,number of sudden cancer pain within 24 hours,and PSQI score among the groups(P>0.05).The NRS score and PSQI score of the HM group patients were signifi-cantly lower than those of the M group at all time points after treatment,and the number of episodes of sudden pain within 24 hours was less than that of the M group patients;The NRS scores of patients in the HM+KET+GBP group were lower than those in the HM group and HM+KET group at 1 day,3 days,7 days,15 days,and 1 month after treatment.At all time points after treatment,the number of episodes of pain within 24 hours was lower than that in the HM group and HM+KET group.The PSQI scores at 1 month and 2 months after treatment were lower than those in the HM group and HM+KET group,and the differences were statistically significant(P<0.05).The safety analysis showed that the incidence of constipation in the HM group was lower than that in the M group.The incidence of nausea,vomiting,constipation,drowsiness,and skin itching in the HM+ KET+GBP group were lower than those in the HM group and HM+KET group,the differences were statistically significant(P<0.05).Survival analysis showed that patients in the HM group had a longer overall survival time than those in the M group(P= 0.042).Conclusion Intrathecal infusion of hydromorphone showed significant advantages in treating refractory cancer pain in nasopharyngeal cancer patients.The combination of hydromorphone,ketamine,and gabapentin demonstrated better efficacy.
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