Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer.
| Autor: | Shulman M; Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA. rmccarth@rpslmc.edu, Harris JE, Lubenow TR, Nath HA, Ivankovich AD |
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| Jazyk: | angličtina |
| Zdroj: | The Clinical journal of pain [Clin J Pain] 2000 Dec; Vol. 16 (4), pp. 304-9. |
| DOI: | 10.1097/00002508-200012000-00005 |
| Abstrakt: | Objective: To compare pain relief in metastatic pancreatic cancer patients between neurolytic celiac plexus block (NCPB) and epidural 5% butamben suspension (EBS), a material-based delivery system of a local anesthetic that produces a long-lasting differential nerve block. Design: Open-label patient-selected parallel groups. Setting: Urban tertiary care medical center. Patients: Twenty-four adult patients with metastatic pancreatic cancer experiencing pain uncontrolled by systemic opioids who were referred to a multidisciplinary pain clinic for interventional therapy. Interventions: Antecrural NCPB-block with ethanol and epidural 5% butamben suspension injections. Measures: Subjective global pain relief assessments on a 0-100% scale were made weekly for 4 weeks and then monthly. Change in opioid use postintervention. Results: Eight patients had a single NCPB and three patients had two NCPB. Four of the former and two of the latter had successful pain relief defined to be a more than 75% reduction in pain when compared with pretreatment maintained for more than 4 weeks or until death (if less than 4 weeks). Thirteen patients received EBS in divided doses. Eleven patients received a cumulative EBS dose of 5 grams, one patient received a cumulative EBS dose of 2.5 grams, and one patient received a cumulative EBS dose of 8.75 grams. Nine of the eleven patients and each of the other two patients had successful pain relief. The overall incidence (85% EBS vs. 55% NCPB), the duration of successful pain relief, and the percent reduction in opioid use did not differ between the two groups. There were no serious complications. Conclusion: EBS appears to be a safe and effective alternative to NCPB in the treatment of pancreatic cancer pain. |
| Databáze: | MEDLINE |
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