Neurolytic celiac plexus block reduces occurrence and duration of terminal delirium in patients with pancreatic cancer

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...

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Bibliographic Details
Published in:Journal of anesthesia 2013-02, Vol.27 (1), p.88-92
Main Authors: Arai, Young-Chang P., Nishihara, Makoto, Kobayashi, Kunio, Kanazawa, Tamotsu, Hayashi, Nobuhiko, Tohyama, Yukio, Nishida, Kikuyo, Arakawa, Maki, Suzuki, Chiharu, Kinoshita, Akiko, Kondo, Miki, Matsubara, Satuki, Yokoe, Nami, Hayashi, Ruiko, Ohta, Aya, Sato, Jun, Ushida, Takahiro
Format: Article
Language:English
Subjects:
Aged
Anesthesiology
Care and treatment
Celiac Plexus
Critical Care Medicine
Delirium
Delirium - etiology
Delirium - prevention & control
Delirium - psychology
Emergency Medicine
Female
Humans
Hypotension - etiology
Intensive
Karnofsky Performance Status
Male
Medicine
Medicine & Public Health
Middle Aged
Nerve Block - adverse effects
Nerve Block - methods
Original Article
Pain Measurement
Pain Medicine
Pain, Intractable - drug therapy
Pain, Intractable - etiology
Pain, Intractable - therapy
Palliative Care
Pancreatic cancer
Pancreatic Neoplasms - complications
Pancreatic Neoplasms - psychology
Physiological aspects
Surgery, Computer-Assisted
Terminal Care
Tomography, X-Ray Computed
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Summary: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  
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-012-1486-3