Document Detail


Neurolytic celiac plexus block reduces occurrence and duration of terminal delirium in patients with pancreatic cancer.
MedLine Citation:
PMID:  22990527     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: WHO's three step ladder sometimes cannot provide adequate pain relief for pancreatic cancer. Some patients develop terminal delirium (TD). The aim of this study was to test if the addition of a celiac plexus block (CPB) to pharmacotherapy could reduce the incidence of TD. METHODS: Pancreatic cancer patients under the care of our palliative-care team were investigated with regard to the duration and occurrence of TD, pain scores [numerical rating score (NRS)] and daily opioid dose. Between August 2007 to September 2008, 17 patients received only pharmacotherapy (control group). Then, we modified our guideline for analgesia, performing CPB 7 days after the first intervention of our team. Between October 2008 to September 2009, 19 patients received CPB. RESULTS: The opioid doses in CPB group were significantly lower both at 10 days after the first intervention (3 days after CPB) (27 ± 11 vs. 66 ± 82 mg; p = 0.029) and 2 days before death (37 ± 25 vs. 124 ± 117 mg; p = 0.009). NRS in the CPB group were significantly lower both at 10 days after the first intervention (0 [0-2] vs. 3 [2-5], p < 0.0001) and 2 days before death (1 [0-2] vs. 3 [1-4.5], p = 0.018). The occurrence and duration of TD in CPB group were both reduced (42 vs. 94 %, p = 0.019; and 1.8 ± 2.9 vs. 10.4 ± 7.5 days, p = 0.0003). CONCLUSION: The duration and occurrence of TD and the pain severity were significantly less in pancreatic cancer patients who underwent neurolytic CPB.
Authors:
Young-Chang P Arai; Makoto Nishihara; Kunio Kobayashi; Tamotsu Kanazawa; Nobuhiko Hayashi; Yukio Tohyama; Kikuyo Nishida; Maki Arakawa; Chiharu Suzuki; Akiko Kinoshita; Miki Kondo; Satuki Matsubara; Nami Yokoe; Ruiko Hayashi; Aya Ohta; Jun Sato; Takahiro Ushida
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-19
Journal Detail:
Title:  Journal of anesthesia     Volume:  -     ISSN:  1438-8359     ISO Abbreviation:  J Anesth     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8905667     Medline TA:  J Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Multidisciplinary Pain Centre, Aichi Medical University, School of Medicine, 21 Karimata, Nagakutecho, Aichigun, Aichi, 480-1195, Japan, arainon@aichi-med-u.ac.jp.
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