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01.02.2013 | Original Article | Ausgabe 1/2013

Journal of Anesthesia 1/2013

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

Zeitschrift:
Journal of Anesthesia > Ausgabe 1/2013
Autoren:
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

Abstract

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.

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