Articles: nerve-block.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain.
Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block (CPB) on pain relief and quality of life (QOL), compared to the traditional NSAID-morphine treatment. The criteria were morphine consumption, visual analogue pain scale (VAS), performance status (PS) determined by medical and nursing staffs, and answers to QOL questionnaires. Morphine consumption, VAS, PS, and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control. ⋯ Self-assessed QOL scores did not ameliorate statistically after CPB; however, they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods, while they deteriorated only slightly in the CPB group. There were fewer side effects after CPB. These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain, but it may prevent deterioration in QOL by the long-lasting analgesic effect, limitation of side effects and the reduction of morphine consumption, compared to treatment only with NSAID-morphine.
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Case Reports
Psoas sheath chemical neurolysis for management of intractable leg pain from metastatic liposarcoma.
A 56-year-old man with widely metastatic liposarcoma, after left Tower extremity amputation, complained of severe right lower extremity pain. Trials of systemic opioids had resulted in poor pain control while introducing intolerable dose-limiting side effects. ⋯ Initial inpatient management consisted of a lumbar epidural infusion of a dilute local anesthetic and preservative-free morphine. This provided satisfactory relief but was discontinued because of recrudescence of phantom limb pain. A lumbar epidural infusion of preservative-free morphine sulfate was associated with poor pain relief, central nervous system (CNS) side effects, and severe urinary retention resulting in acute renal failure. A repeated trial of parental opioids provided marginal pain relief with persistent CNS side effects. Chemical neurolysis of the lumbar plexus was performed with 10 ml of 10% aqueous phenol injected into the psoas muscle sheath. The pain gradually resolved over a 2-day period without apparent side effects. Motor function was preserved, pain was resolved, and as systemic opioids were reduced, cognitive function and overall well-being were improved.
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Acta Anaesthesiol Scand · Mar 1996
Randomized Controlled Trial Clinical TrialIs preoperative ketorolac a useful adjunct to regional anesthesia for inguinal herniorrhaphy?
Nonsteroidal antiinflammatory drugs (NSAIDs) have become a popular component of analgesia regimens, particularly in combination with narcotics. We questioned whether there might also be a place for their use in conjunction with regional anesthesia and whether there was a preferable route for NSAID administration. ⋯ Beyond the analgesia provided by the regional anesthesia of the ilioinguinal and field blocks, the preoperative use of ketorolac further reduced postoperative pain scores and the need for additional postoperative analgesic medication. Comparable outcomes for the i.v., i.m. and i.w. groups indicate the lack of any benefit to concentrating the non-steroidal anti-inflammatory drug at the wound (i.w.) or to achieving high blood levels rapidly (i.v.). In conclusion, ketorolac is a useful supplement to ilioinguinal plus field block regional anesthesia for hernia surgery and is most effective administered parenterally.
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Two hundred patients with upper-abdominal malignancy were treated with oral morphine sulfate (OMS) during a 2-year period. Twenty-five of these patients experienced left-sided dragging pain and epigastric discomfort following a few months of adequate pain relief. An increase in the OMS did not relieve the pain. ⋯ All of these patients continued to receive OMS without reduction in dose. Three patients required repeat block after 90 days. This experience documents the value of unilateral celiac plexus block as an adjuvant technique for the management of pain due to upper abdominal cancer.
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Comparative Study
[Efficacy of continuous intercostal analgesia versus epidural analgesia on post-thoracotomy pain].
The authors compare the efficacy of epidural morphine analgesia with continuous intercostal extrapleural block using bupivacaine 0.5% after thoracotomy. They affirm that antalgic treatment in thoracotomised patients is the most important factor in preventing the onset of major complications that may negatively influence the results of surgery. The efficacy of the analgesic techniques examined was evaluated using El-Baz's visual analogic scale of pain, through the analysis of spirometric values and on the incidence of postoperative complications. The authors demonstrate that the extrapleural continuous nerve block is a reliable method of post-thoracotomic analgesia.