This article shows that ETX is not effective to treat neuropathic pain. Nevertheless, per-protocol analysis suggests a possible analgesic effect of ETX. Thus, our work adds significant knowledge to preclinical and clinical data on the benefits of T-type calcium channel inhibition for the treatment of neuropathic pain.
Nerve-sparing radical hysterectomy by robot-assisted laparoscopy is feasible in early cervical cancer (<2 cm). A total of 93.3 % of the patients were discharged 2 days after surgery with spontaneous voiding. The next step would be a prospective study with objective urodynamic investigations.
Background: Ziconotide is a new analgesic agent administered intrathecally. It is challenging
to use and can induce several and sometimes serious adverse events. A low initial dosage
followed by slow titration may reduce serious adverse events.
Objective: To determine whether a low starting dosage of ziconotide, followed by slow
titration, decreases the incidence of major adverse events associated with ziconotide when
used for intractable cancer pain.
Study Design: Observational cohort study.
Setting: Three French cancer centers.
Methods: Patients with incurable cancer causing chronic pain rated above 6/10 on
a numerical scale while receiving high-dose opioid therapy (more than 200 mg/d of oral
morphine equivalent) and/or exhibiting severe opioid-related adverse events received
intrathecal infusions of ziconotide combined with morphine, ropivacaine, and clonidine.
Results: Seventy-seven patients were included. Adverse events were recorded in 57%
of them; moderate adverse events occurred in 51%. Adverse events required treatment
discontinuation in 7 (9%) including 5 (6%) for whom a causal role for ziconotide was highly
likely; among them 4 (5%) were serious. All patients experienced a significant and lasting
decrease in pain intensity (by 48%) in response to intrathecal analgesic therapy that included
ziconotide.
Limitations: Limitations include the nonrandomized, observational nature of the study.
Determining the relative contributions of each drug to adverse events was difficult, and some
of the adverse events manifested as clinical symptoms of a subjective nature.
Conclusions: The rates of minor and moderate adverse events were consistent with
previous reports. However, the rate of serious adverse events was substantially lower. Our
study confirms the efficacy of intrathecal analgesia with ziconotide for relieving refractory
cancer pain. These results indicate that multimodal intrathecal analgesia in patients with
cancer pain should include ziconotide from the outset in order to provide time for subsequent
slow titration.
Key words: Ziconotide, adverse events, intrathecal therapy, cancer pain, morphine,
ropivacaine, clonidine.
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