1
|
Lee YC, Brake T, Zhao E, Dumitrescu A, Lee W, Tassie B, Khor KE, Wang AYY. The use of interventional procedures for cancer pain. A brief review. Support Care Cancer 2024; 32:285. [PMID: 38607568 PMCID: PMC11009760 DOI: 10.1007/s00520-024-08467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
CONTEXT Pain is a common experience in people living with cancer. Concerns around opioid prescribing have seen a move toward a multi-modality management approach, which includes interventional pain procedures. PURPOSE In this paper we discuss the interventional pain procedures used to treat cancer pain at two major tertiary centers in Australia. METHODS AND RESULTS This expert review provides practical insights on cancer pain management from healthcare providers in different specialties. These insights can be used to guide the management of a wide range of cancer pain types. CONCLUSIONS Furthermore, this review identifies the need for a systematic and comprehensive approach to the management of cancer pain that is broader than that of a single specialty. With recent advances in pain management procedures, an interdisciplinary approach is essential in order to provide an up to date, patient tailored approach to pain management. This review will help inform the development of a cancer pain intervention registry.
Collapse
Affiliation(s)
- Yi-Ching Lee
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.
- Department of Anaesthetics and Pain Service, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Timothy Brake
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Emma Zhao
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
- Department of Anaesthetics and Pain Service, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Nursing School, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Alix Dumitrescu
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Department of Palliative Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wei Lee
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- HammondCare, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Clinical School, University of Sydney, St Leonards, Australia
| | - Benjamin Tassie
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia
| | - Kok-Eng Khor
- Pain Management Department, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andy Yi-Yang Wang
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Level 4, QEII, Missenden Rd, Camperdown, Sydney, NSW, 2050, Australia.
- Department of Anaesthetics and Pain Service, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
- School of Medicine, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
2
|
Winters KD, Byrne J, Eckholm N, Atayee RS, Furnish T. Palliation of Intractable Cancer-Related Pain With Low-Dose Epidural Bupivacaine. J Palliat Med 2024; 27:434-437. [PMID: 37610860 DOI: 10.1089/jpm.2023.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Introduction: Patients with advanced cancer nearing end of life often present with complex multifactorial pain. Although epidural analgesia is routinely used in inpatient hospital settings for targeted pain control, there is scant description in the literature of the use of low-dose epidural analgesia for relief of cancer-related pain at end of life. In this study, we present a case of difficult to control cancer-related rectal and pelvic pain in a patient who responded well in her last days of life to a low-dose bupivacaine epidural. Case Description: A 66-year-old woman presented for inpatient hospital admission for pain control from home hospice with intractable cancer-related pain from metastatic colorectal adenocarcinoma marked by extensive erosive lesions extending from the anterior perineum to the posterior rectum, with rectovaginal fistula. The patient reported poor tolerance of medications and described spiritual beliefs (based in Buddhism) that caused her and her family to prioritize maintaining a lucid, clear mind above nearly all else while seeking symptom management. The patient was so debilitated by pain at the time of presentation that she was bedbound in a quadruped position. Case Management and Outcome: After 2 weeks of poor pain control in the hospital with multiple failed attempts at palliation-including bilateral pudendal block, as well as opioids and other routine, but potentially sedating or deliriogenic, medications to treat her pain-the patient permitted administration of a low-dose bupivacaine epidural that significantly reduced her pain and allowed the patient to remain clear-headed up until the time of her death. Twenty-three days after admission, and 5 days after initiation of low-dose bupivacaine epidural for pain control, the patient died peacefully in the hospital. Conclusion: Low-dose epidural analgesia for cancer-related pain at end of life from malignancy involving the pelvis-perineum, rectum, or vagina-may be a viable option for patients, particularly those who wish to avoid the risk of somnolence or confusion from systemic opioids and other analgesics.
Collapse
Affiliation(s)
- Kathryn D Winters
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jennifer Byrne
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
| | - Natasha Eckholm
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
| | - Rabia S Atayee
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, USA
- Department of Pharmacy, University of California Health, La Jolla, California, USA
| | - Timothy Furnish
- Department of Anesthesiology, UC San Diego Health, San Diego, California, USA
| |
Collapse
|
3
|
Wang DY, Feng D, Liu MY, Wu W, Xu H, Shi H. Ultrasound-guided serratus anterior plane block to prevent neurocognitive impairment in elderly patients after thoracoscopic lobectomy: protocol for a single-centre, double-blind, randomised controlled trial. BMJ Open 2023; 13:e069652. [PMID: 38081670 PMCID: PMC10729046 DOI: 10.1136/bmjopen-2022-069652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Postoperative neurocognitive dysfunction (PND), including postoperative delirium (POD), is a common complication in elderly patients after major surgeries, often leading to poor postoperative recovery. Although the pathological mechanism underlying PND is still unclear, postoperative pain is strongly associated with the development of PND. The ultrasound-guided serratus anterior plane block (SAPB) has been reported to relieve postoperative pain in thoracic surgery. Therefore, this prospective trial hypothesises that SAPB may reduce the incidence of PND in the elderly undergoing thoracoscopic lobectomy. METHODS AND ANALYSIS This study is designed as a single-centre, double-blind, randomised controlled clinical trial. A total of 256 elderly patients scheduled to undergo thoracoscopic lobectomy at Shanghai Pulmonary Hospital will be randomly assigned to general anaesthesia group or SAPB group. The primary outcome is the incidence of PND 7 days postoperatively or before discharge from hospital. The secondary outcomes include the occurrence of POD, the postoperative pain scores, Quality of Recovery at 1-2 days postoperatively and incidence of PND at 3 months postoperatively. The levels of fasting blood glucose in peripheral blood will be examined before and 1-2 days postoperatively. ETHICS AND DISSEMINATION The trial has been approved by the Clinical Research Ethics Committee of Shanghai Pulmonary Hospital (identifier: K20-290). All participants will be required to provide written informed consent before any protocol-specific procedures. Findings will be disseminated in a peer-reviewed journal and in national and/or international meetings to guide future practice. TRIAL REGISTRATION NUMBER ChiCTR2100052633.
Collapse
Affiliation(s)
- Dan-Yang Wang
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Di Feng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mei-Yun Liu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Wu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Huan Xu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
4
|
Yek JLJ, Oey N, Jain A, Liu C, Angamuthu N. Continuous Tunneled Infraclavicular Nerve Catheter for Palliative Management of Critical Limb Ischemia: A Case Report. J Palliat Med 2023; 26:1551-1554. [PMID: 37699230 DOI: 10.1089/jpm.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We describe the successful use of a continuous local anesthetic infusion via an infraclavicular nerve catheter to control severe refractory ischemic upper limb pain in a patient with metastatic lung cancer for whom surgical and pharmacological intervention was unsuccessful. As her opioid requirements increased due to worsening ischemic pain, she subsequently developed opioid toxicity, hence prompting the palliative use of a tunneled infraclavicular nerve catheter under ultrasound guidance to minimize opioid requirements. Her opioid requirements tailed down subsequently with the successful insertion of the infraclavicular nerve catheter and she remained pain free till her death. Palliative use of nerve catheters is a safe and an effective alternative in patients with refractory cancer pain, and we describe our methods to prolong its use and minimizing its associated long-term complications.
Collapse
Affiliation(s)
- Jia Lin Jacklyn Yek
- Department of Anaesthesiology and Perioperative Medicine and Singapore General Hospital, Singapore, Singapore
| | - Nicodemus Oey
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Amit Jain
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Christopher Liu
- Department of Anaesthesiology and Perioperative Medicine and Singapore General Hospital, Singapore, Singapore
| | - Nithia Angamuthu
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| |
Collapse
|