Peripheral nerve blocks in advanced cancer pain: retrospective case series

2021 ◽  
pp. bmjspcare-2021-003293
Author(s):  
Erika Anna Sofia Rouhento ◽  
Juho T Lehto ◽  
Maija-Liisa Kalliomäki
Keyword(s):  
Pain Relief ◽  
Peripheral Nerve ◽  
Advanced Cancer ◽  
Nerve Block ◽  
Severe Pain ◽  
Case Series ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Patient Reported ◽  
Morphine Equivalent

ObjectivesPatients with cancer often suffer severe pain that is not relieved with systemic analgesics and requires further treatment options. This study aims to investigate whether peripheral nerve blocks are a feasible treatment option in patients with incurable cancer who suffer from severe pain.MethodsAll patients with advanced cancer who received a peripheral nerve block for the management of pain at the Tampere University Hospital between January 2015 and December 2018 were included in this retrospective study. The characteristics of the patients’ features of the nerve blocks, opioid dosing (daily morphine equivalent) before and after the blocks, and patient-reported pain relief following peripheral block were assessed from the medical records.ResultsSixteen of the 17 patients included in this study received pain relief through a nerve block. Daily opioid dose was decreased with the block in 12 (71%) patients with a median change in daily morphine equivalent of −20 mg (IQR: −180 to 9). One infection of the catheter and two other transient adverse events occurred, but none was serious or fatal.ConclusionsPeripheral nerve blocks seem safe and may provide considerable analgesia and decrease the need for opioids in patients with advanced cancer.

scholarly journals The Use of Long Acting Opioids to Prevent Rebound Pain Following Peripheral Nerve Blocks for Outpatient Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Leah Herzog ◽  
Sylvia H. Wilson ◽  
Christopher E. Gross
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Pain Medication ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Pain Scores ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Long Acting

Category: Ankle; Bunion Introduction/Purpose: Peripheral nerve blocks have become an integral part of orthopedic surgery to assist with postoperative pain. However, 40% of patients who undergo a peripheral nerve block will experience rebound pain, which in turn, long-acting narcotics may be able to block. Unfortunately, this rebound pain can cancel out the potential benefits of decreased opioid medication use. Therefore, this study seeks to compare the difference in patient reported pain scores in those patients whom received long-acting opioid pain medication and those who did not. Methods: This is a retrospective review of patient-reported pain scores for 96 patients who underwent a peripheral nerve block for outpatient foot and ankle surgery. 48 patients either received three days of long-acting opioids or did not. Each patient was asked to fill out and return a pain diary as well as fill out a pain catastrophizing survey (PCS) at their postoperative appointment. The pain diary discussed their Visual Analogue Scale pain scores, amount of pain medication, and time they took the medicine. This data was then collected and compared via paired student t-tests for evaluation of significance. Results: Pain diaries were completed by 69 patients (72%). There were no significant differences between those comorbidities, types of procedures, age, or BMI between the groups. Mean postoperative pain scores did not differ between patients that did and did not receive postoperative extended release opioid medications (p = 0.226). Mean opioid consumption did not differ between groups (p = 0.945). There were no correlations between daily reported pain scores or the postoperative day with the highest pain score for those who received long acting opioid pain medication versus those who did not (r=0.336, p=0.550). Conclusion: Rebound pain is a difficult potential side effect of peripheral nerve blocks that currently does not have a preventative measure. This study was an attempted effort to help eliminate rebound pain, but there did not appear to be a significant benefit to adding long-acting opioid pain medication in addition to the peripheral nerve block and short-acting pain medication

The Effects of Perioperative Peripheral Nerve Blocks on Peri- and Postoperative Opioid Use and Pain Management

2021 ◽  
pp. 000313482110233
Author(s):  
Taylor W. Cardwell ◽  
Vanessa Zabala ◽  
Jocelyn Mineo ◽  
Christopher N. Ochner
Keyword(s):  
Pain Management ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Pain Scores ◽  
Patient Reported ◽  
Postoperative Physical Therapy

Introduction The amount of peri- and post-operative use of opioids for pain management, and the duration in which they are used following surgery, are positively associated with the likelihood of subsequent opioid use and addiction. Aware of this issue, many clinicians are seeking ways to reduce opioid use while maintaining adequate pain management. Recent evidence suggests that peripheral nerve block utilization may present a viable mechanism by which clinicians can accomplish this goal. Methods Ovid MEDLINE and Pubmed databases were searched to identify relevant articles. Using the advanced search option, the key terms “opioid,” “morphine,” “nerve block,” “peripheral anesthesia,” “pain management,” “preoperative,”, “intraoperative,” and “postoperative” were used and combined with the Boolean terms “AND” and “OR.” This review examines the extant literature surrounding the use of peripheral nerve blocks in relation to patient-reported pain scores, intraoperative opioids, postoperative opioids, patient-controlled analgesic with opioids, and opioid consumption once the patient has left the hospital. Further, the effect peripheral nerve blocks have on postoperative physical therapy, surgery related complications, and overall patient satisfaction are briefly discussed. Results The use of perioperative peripheral nerve blocks decreases opioid consumption not only in the postoperative period, but also intraoperatively as well. The most significant decrease in opioid consumption is seen in the first 24-72 hours postoperatively. Patient reported pain scores were also lower in patients who received peripheral nerve blocks. Discussion Despite relatively robust efficacy data, utilization of peripheral nerve blocks is not ubiquitous; the potential reasons for which are also discussed. Lastly, clinical recommendations based on the available data are provided.

scholarly journals Ultrasound-guided peripheral nerve blocks in anticoagulated patients – case series

2017 ◽  
Vol 67 (1) ◽  
pp. 100-106
Author(s):  
Luis Eduardo Silveira Martins ◽  
Leonardo Henrique Cunha Ferraro ◽  
Alexandre Takeda ◽  
Masashi Munechika ◽  
Maria Angela Tardelli
Keyword(s):  
Peripheral Nerve ◽  
Case Series ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Anticoagulated Patients

scholarly journals Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

2015 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Brendan Carvalho ◽  
Romy D. Yun ◽  
Edward R. Mariano
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Single Injection ◽  
Clinical Care ◽  
Personnel Cost ◽  
Additional Time ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

scholarly journals Effect of Anaesthesiologists’ Experience on Preferred Technique and Volume of Local Anaesthetic Administered for Brachial Plexus Nerve Block: A Retrospective Observational Analysis

2021 ◽  
Author(s):  
Depinder Kaur ◽  
Reena Mahajan ◽  
Shiv Kumar Singh ◽  
Suchitra Malhotra
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Failure Rate ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Block Group ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Group A ◽  
Group B

Introduction: Faculty and Residents are trained in peripheral nerve blocks guided by blind technique, Peripheral Neuro Stimulator (PNS) or Ultrasound (USG) guided technique. But due to unavailability of USG machine in all institutes and requiring special training, techniques used for peripheral nerve blocks vary from institute to institute. Aim: To analyse the effect of anaesthesiologists’ experience on preferred technique and Local Anaesthetic (LA) volume used for brachial plexus nerve block retrospectively. Materials and Methods: In this retrospective observational study, 129 adults American Society of Anesthesiologists (ASA) grade I and II patients requiring brachial plexus nerve block for upper limb orthopaedic surgical anaesthesia for both elective and emergency surgery were divided into three groups for each year depending on technique for nerve block used. Group A: Received USG guided (Micromaxx Sonosite Inc, USA) brachial plexus nerve block. Group B: Received peripheral nerve stimulator (Inmed) guided brachial plexus nerve block. Group C: Received brachial plexus nerve block by traditional anatomical landmark based paraesthesia elicitation blind technique. Patients with inadequate surgical analgesia were given general anaesthesia and were categorised as failure rate. Year wise demographic data, type of technique used for giving brachial plexus nerve block, volume of drug used, failure rate, complications observed were collected and analysed by Student’s t-test and Chi-square test. Results: USG guided technique was the most prefered technique in both years (57.6%, n=38 in year 2018 and 49.2%, n=31 in year 2019). In remaining nearly half of the patients PNS and blind technique was used (PNS 24.2%, n=16 in year 2018 and 20.6%, n=13 in year 2019; blind technique 18.2%, n=12 in year 2018 and 30.2%, n=19 in year 2019). Significantly, less volume of LA drug (mL) was used in group A in year 2019 (16.43±6.07) than in year 2018 (22.34±4.75) (p<0.001). Failure rate in group A in year 2019 (3.2%) was significantly less than in year 2018 (5.2%), but the difference was insignificant in all three groups. In group A, no complications were observed in year 2019 while one incidence of hemidiaphragm paralysis was observed in year 2018, while in group B and C, complications were observed in both years. Conclusion: USG guided nerve block was the most preferred technique for nerve block in the study institute. In 24 months observation period, with increasing experience with USG there was significant increase in success rate and decrease in the volume of LA administered and complications.

scholarly journals Investigation of a New Echogenic Needle for use with Ultrasound Peripheral Nerve Blocks

2007 ◽  
Vol 35 (4) ◽  
pp. 582-586 ◽  
Author(s):  
R. K. Deam ◽  
R. Kluger ◽  
J. Barrington ◽  
C.A. McCutcheon
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Regional Anaesthesia ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Ultrasonic Image

A new ‘texturing method’ has been developed for nerve block needles in an attempt to improve the ultrasonic image of the needles. Using a synthetic phantom, these textured needles were compared to currently available needles. The textured needle had improved visibility under ultrasound. This type of needle may assist the anaesthetist perform ultrasound-guided regional anaesthesia.

A case series of peripheral nerve blocks in pediatrics and young adults with skeletal dysplasia

2016 ◽  
Vol 26 (5) ◽  
pp. 553-556 ◽  
Author(s):  
James R. Eiszner ◽  
Alfred Atanda ◽  
Ashwin Rangavajjula ◽  
Mary Theroux
Keyword(s):  
Young Adults ◽  
Peripheral Nerve ◽  
Skeletal Dysplasia ◽  
Case Series ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

scholarly journals Does Rebound Pain after Peripheral Nerve Block for Orthopedic Surgery Impact Postoperative Analgesia and Opioid Consumption? A Narrative Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3257 ◽  
Author(s):  
Olufunke Dada ◽  
Alicia Gonzalez Zacarias ◽  
Corinna Ongaigui ◽  
Marco Echeverria-Villalobos ◽  
Michael Kushelev ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Opioid Consumption ◽  
Orthopedic Procedures ◽  
Negative Consequences ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
The Impact

Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

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