Audit of neural blockade for palliative care patients in an acute unit

Abstract

During the period from September 1990 to March 1992, 155 nerve blocks were performed for 125 patients as part of the clinical management of pain due to malignant disease. The efficacy, in terms of pain score reduction, and spontaneously reported side effects secondary to these procedures were prospectively audited. Neural blockade was undertaken in accordance with strict clinical criteria, and medication was optimized with the aim of achieving maximum analgesia with minimum side effects at all times. Pain was assessed before the block, 24 hours after the block and at follow-up (two to six weeks) using visual analogue scores or verbal rating scales. All patients were audited. The total (all patients, all blocks) median (lower-upper quartile) pain score dropped from 8 (6-10) cm before the block to 2 (0-4) cm at 24 hours after the block (p < 0.05) and to 1 (0-4) cm at follow-up (p < 0.005). A concomitant reduction in analgesic requirements was observed. The incidence of serious side effects was low (two patients in this series). The results indicate the usefulness of these techniques for patients in the palliative care setting.

Block of Interdigital Nerves for Cancer Pain

“…Many minor procedures that do not require the availability of radiography may be undertaken in a hospice setting. 3 Well-localized pain can be relieved more easily, while large painful areas innervated by multiple nerves may require more central blocks. The following case illustrates the benefits that can occur from a peripheral block in the context of palliative care.…”

Opioid Poorly-Responsive Cancer Pain. Part 3. Clinical Strategies to Improve Opioid Responsiveness

“…Efficacy and safety of neural blockade has been demonstrated in more than 90% of cases, resulting in prolonged pain relief that outlasts the pharmacological action of the drug used. 175 The long-lasting beneficial effects after non-neurolytic blockade can be explained by a prolonged interruption of transmission by afferent somatic and/or sympathetic fibers from the painful area to the central nervous system, interrupting the self-sustaining abnormal stimulation initiated by the chronic pain state. Location and type of pain are of primary importance in considering the patient selection.…”

Management of chronic pain

“…There is little hard evidence from well-constructed clinical trials that favour the use of therapeutic nerve block as a method of treatment. The best examples have been found in neuroly tic blockade for pain arising from cancer (Boys et al, 1993). However, there is always the danger in any destructive or permanent procedure involving damage to the nerves that pain may return because of damage to the existent efferent stump.…”