Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectives

Sanjeet Narang , Jason Yong , David Hao
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Abstract

Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination. By reframing neuraxial analgesia not as an extraordinary measure, but as a legitimate and potentially transformative option, we advocate for broader, more equitable integration of these therapies.
重新考虑生命末期的神经轴镇痛:临床、伦理和社会经济观点
疼痛是接近生命终点的患者最普遍和最痛苦的症状之一,特别是在癌症患者中。虽然全身性阿片类药物是治疗的主要手段,但其局限性需要考虑替代策略。轴向镇痛,包括硬膜外和鞘内给药系统,提供有针对性的疼痛缓解,减轻全身负担。然而,尽管有支持性数据,由于临床、伦理、后勤和社会经济障碍,这些干预措施仍未得到充分利用。这篇文章探讨了在生命结束时提供神经轴镇痛所涉及的复杂决策,权衡风险和收益,改变病人的目标,以及护理协调的挑战。通过重新定义神经轴镇痛,而不是作为一种特殊的措施,而是作为一种合法的、潜在的变革选择,我们提倡更广泛、更公平地整合这些疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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