WordNet

any solution that is injected (as into the skin) (同)injectant
the act of putting a liquid into the body by means of a syringe; "the nurse gave him a flu shot" (同)shot
the forceful insertion of a substance under pressure

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〈U〉〈C〉注射,注入 / 〈C〉注射液

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/15 05:21:38」(JST)

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Intrathecal (intra- + theca, "within a sheath") is an adjective that refers to something occurring in or introduced into the anatomic space or potential space inside a sheath, most commonly the arachnoid membrane of the brain or spinal cord^[1] (under which is the subarachnoid space). For example, intrathecal immunoglobulin production is production of antibodies in the spinal cord,^[2] and an intrathecal injection (often simply called "an intrathecal") is a route of administration for drugs via an injection into the spinal canal, more specifically into the subarachnoid space so that it reaches the CSF and is useful in spinal anaesthesia, chemotherapy, or pain management applications. This route is also used to introduce drugs that fight certain infections, particularly post-neurosurgical. The drug needs to be given this way to avoid the blood brain barrier. The same drug given orally must enter the blood stream and may not be able to pass out and into the brain. Drugs given intrathecally often have to be made up specially by a pharmacist or technician because they cannot contain any preservative or other potentially harmful inactive ingredients that are sometimes found in standard injectable drug preparations.

The abbreviation "IT" is best not used; instead, "intrathecal" is spelled out to avoid medical mistakes.

Intrathecal administration of analgesic agents

Very popular for a single 24-hour dose of analgesia (opioid with local anesthetic)
Caution because of late onset respiratory depression
Severe pruritus and urinary retention may limit the use of intrathecal morphine
Pethidine has the unusual property of being both a local anaesthetic and opioid analgesic which occasionally permits its use as the sole intrathecal anaesthetic agent
Ziconotide is a conotoxin-derived peptide used for chronic pain therapy within the United States. Ziconotide has not been tested in Australia, and there are currently no plans (and, indeed, active opposition to) conotoxin compounds for use in intrathecal pumps. Ziconotide itself has been limited to a specific subset of pumps, due to its affinity to metals. However, the compounds created are not introduced to the intrathecal space.

Intrathecal chemotherapy

Currently, only three agents are licensed for intrathecal chemotherapy
- They are methotrexate, cytarabine (Ara-C) and hydrocortisone.
Administration of other chemotherapeutic agents such as vincristine via the intrathecal route can lead to fatal outcomes.^[3]^[4]

Intrathecal baclofen

Often reserved for spastic cerebral palsy, intrathecally-administered baclofen is done through an intrathecal pump implanted just below the skin of the stomach, (or behind the chest wall, depending on the surgeon implanting the device, and patient preferences), with a tube (called the 'catheter') connected directly to the base of the spine, where it bathes the spinal cord using a dose about one thousand times smaller than that required by orally-administered baclofen. Intrathecal baclofen also carries none of the side effects, such as sleepiness, that typically occur with oral baclofen. However, intrathecal baclofen pumps carry serious clinical risks, such as infection or a possibly fatal sudden malfunction, that oral baclofen does not.

A tremendous amount of care is taken to ensure the optimal location of the pump and catheter, based upon medical considerations and patient requirements.

References

^ "Route of Administration". Data Standards Manual. Food and Drug Administration. Retrieved 11 March 2011.
^ Meinl, E; Krumbholz, M; Derfuss, T; Junker, A; Hohlfeld, R (2008). "Compartmentalization of inflammation in the CNS: a major mechanism driving progressive multiple sclerosis". Journal of the neurological sciences 274 (1–2): 42–4. doi:10.1016/j.jns.2008.06.032. PMID 18715571.
^ Schulmeister L (September 2004). "Preventing vincristine sulfate medication errors". Oncology Nursing Forum 31 (5): E90–8. doi:10.1188/04.ONF.E90-E98. PMID 15378106.
^ Qweider M, Gilsbach JM, Rohde V (March 2007). "Inadvertent intrathecal vincristine administration: a neurosurgical emergency. Case report". Journal of Neurosurgery. Spine 6 (3): 280–3. doi:10.3171/spi.2007.6.3.280. PMID 17355029.

UpToDate Contents

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English Journal

Intrathecal 1% 2-chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer-blinded, randomised, controlled trial.

Camponovo C1, Wulf H, Ghisi D, Fanelli A, Riva T, Cristina D, Vassiliou T, Leschka K, Fanelli G.Author information 1Department of Anaesthesiology, Regional Hospital, Lugano, Switzerland.AbstractBACKGROUND: This prospective, observer-blinded, randomised, multicentre study aimed at determining the non-inferiority of 50 mg of plain 1% 2-chloroprocaine vs. 10 mg of 0.5% plain bupivacaine in terms of sensory block onset time at T10 after spinal injection. The study hypothesis was that the difference in onset times of sensory block to T10 between the two drugs is ≤ 4 min.
Acta anaesthesiologica Scandinavica.Acta Anaesthesiol Scand.2014 May;58(5):560-6. doi: 10.1111/aas.12291. Epub 2014 Mar 6.
BACKGROUND: This prospective, observer-blinded, randomised, multicentre study aimed at determining the non-inferiority of 50 mg of plain 1% 2-chloroprocaine vs. 10 mg of 0.5% plain bupivacaine in terms of sensory block onset time at T10 after spinal injection. The study hypothesis was that the d
PMID 24601887

The management of intractable pain with adjuvant pulsed electromagnetic field therapy.

Niezgoda JA1, Hardin ST, Kubat N, Acompanado J.Author information 1Jeffrey A. Niezgoda, MD, FACHM, MAPWCA, CHWS, is Associate Professor at the Medical College of Wisconsin, Milwaukee, Wisconsin. Scott T. Hardin, MD, is Medical Director of Rehabilitation Services at the Aurora St. Luke's Medical Center, Milwaukee, Wisconsin. Nicole Kubat, PhD, is an Independent Contract Consultant for Regenesis Biomedical, Inc, Scottsdale, Arizona. Jocelyn Acompanado, PA-C, is a Physician's Assistant in the Department of Rehabilitation Services at the Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.AbstractThis case describes a 51-year-old woman who reported experiencing severe, constant pain, diffusely located in the region of her right mandible neck (primarily involving the mandible, lower right molars, the neck, the upper back, and the shoulder) during the course of several years. Surgical interventions (root canal, spinal fusion) were performed to address potential sources of pain. Despite these interventions, the patient reported severe pain after both surgeries, which persisted beyond the acute postoperative period. Additional pharmacological interventions and physical therapy were also attempted; nonetheless, the patient reported that pain remained severe and constant for approximately 2 years. On the basis of the patient's poor response to conventional treatments, a novel approach of botulinum toxin (BTX) injections was initiated. When pulsed electromagnetic field therapy was added, the need for BTX injections decreased, with the patient reporting a noticeable decrease in pain intensity and an improvement in quality of life measures. Currently, the patient continues to use pulsed electromagnetic field therapy regularly for pain management, which has allowed her to reduce the use of other interventions and avoid continued use of narcotic medications. Considering the need for multifaceted pain management approaches in the treatment of chronic pain, this case is relevant for wound care practitioners attending to patients with chronic postincisional wound pain because the outcome highlights the utility of a nonpharmacological, complementary pain management intervention for closed, yet persistently painful, postoperative wounds.
Advances in skin & wound care.Adv Skin Wound Care.2014 May;27(5):205-9. doi: 10.1097/01.ASW.0000445951.44967.ca.
This case describes a 51-year-old woman who reported experiencing severe, constant pain, diffusely located in the region of her right mandible neck (primarily involving the mandible, lower right molars, the neck, the upper back, and the shoulder) during the course of several years. Surgical interven
PMID 24732123

A novel p38 MAPK docking-groove-targeted compound is a potent inhibitor of inflammatory hyperalgesia.

Willemen HL1, Campos PM2, Lucas E, Morreale A3, Gil-Redondo R3, Agut J4, González FV4, Ramos P, Heijnen C, Mayor F, Kavelaars A, Murga C.Author information 1*Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands.2†Departamento de Biología Molecular and Centro de Biología Molecular "Severo Ochoa" UAM-CSIC, Madrid, Spain.3§Centro de Biología Molecular "Severo Ochoa", UAM-CSIC, Madrid, Spain.4¶Departament de Química Inorgànica i Orgànica, Universitat Jaume I, Castelló, Spain.AbstractThe MAPK (mitogen-activated protein kinase) p38 is an important mediator of inflammation and of inflammatory and neuropathic pain. We have described recently that docking-groove-dependent interactions are important for p38 MAPK-mediated signal transduction. Thus virtual screening was performed to identify putative docking-groove-targeted p38 MAPK inhibitors. Several compounds of the benzo-oxadiazol family were identified with low micromolar inhibitory activity both in a p38 MAPK activity assay, and in THP-1 human monocytes acting as inhibitors of LPS (lipopolysaccharide)-induced TNFα (tumour necrosis factor α) secretion. Positions 2 and 5 in the phenyl ring are essential for the described inhibitory activity with a chloride in position 5 and a methyl group in position 2 yielding the best results, giving an IC50 value of 1.8 μM (FGA-19 compound). Notably, FGA-19 exerted a potent and long-lasting analgesic effect in vivo when tested in a mouse model of inflammatory hyperalgesia. A single intrathecal injection of FGA-19 completely resolved hyperalgesia, being 10-fold as potent and displaying longer lasting effects than the established p38 MAPK inhibitor SB239063. FGA-19 also reversed persistent pain in a model of post-inflammatory hyperalgesia in LysM (lysozyme M)-GRK2 (G-protein-coupled-receptor kinase)+/- mice. These potent in vivo effects suggested p38 MAPK docking-site-targeted inhibitors as a potential novel strategy for the treatment of inflammatory pain.
The Biochemical journal.Biochem J.2014 May 1;459(3):427-39. doi: 10.1042/BJ20130172.
The MAPK (mitogen-activated protein kinase) p38 is an important mediator of inflammation and of inflammatory and neuropathic pain. We have described recently that docking-groove-dependent interactions are important for p38 MAPK-mediated signal transduction. Thus virtual screening was performed to id
PMID 24517375

Japanese Journal

Antinociceptive Effects of Intrathecal Landiolol Injection in a Rat Formalin Pain Model

Mizobuchi Satoshi,Matsuoka Yoshikazu,Obata Norihiko,Kaku Ryuji,Itano Yoshitaro,Tomotsuka Naoto,Taniguchi Arata,Nishie Hiroyuki,Kanzaki Hirotaka,Ouchida Mamoru,Morita Kiyoshi
Acta Medica Okayama 66(3), 285-289, 2012-06-00
… In this study, to investigate the antinociceptive effects and the analgesic profile of landiolol, we examined the effects of intrathecal landiolol administration on nociceptive pain behavior and c-fos mRNA expression (a neural marker of pain) in the spinal cord using a rat formalin model. … We found that pain-related behavior was inhibited by intrathecal landiolol administration. … Thus, intrathecal administration of landiolol exhibited antinociceptiveeffects. …
NAID 120004247100

Effect of Spinally Administered Simvastatin on the Formalin-Induced Nociceptive Response in Mice

Ohsawa Masahiro,Mutoh Junpei,Yamamoto Shohei [他],ONO Hideki,HISA Hiroaki
Journal of pharmacological sciences 119(1), 102-106, 2012-05-20
… Intrathecal administration of simvastatin at doses of 0.5 – … Intracerebroventricular injection of simvastatin (50 nmol) did not affect the formalin-induced nociception. …
NAID 10030760520

最新原著レビュー後方経路腰椎椎体間固定術術後疼痛に対する先取り鎮痛法の比較研究 : 持続モルヒネ皮下投与法単独とくも膜内モルヒネ微量投与との併用法

湯川泰紹
整形外科 63(5), 487-489, 2012-05-00
NAID 40019302697

Related Pictures

★リンクテーブル★

リンク元	「spinal injection」「intraspinal injection」「くも膜下腔内注射」「髄腔内注入法」
関連記事	「injection」「intrathecal」

「spinal injection」

Subarachnoid space
	Diagrammatic representation of a section across the top of the skull, showing the membranes of the brain, etc. ("Subarachnoid cavity" visible at left.)
	Diagrammatic transverse section of the medulla spinalis and its membranes. (Subarachnoid cavity colored blue.)
Details
Latin	Spatium subarachnoideum,; cavum subarachnoideale
Identifiers
Gray's	p.876
MeSH	A08.186.566.166.686
Dorlands; /Elsevier	s_16/12746651
	Anatomical terminology