Transversus abdominis plane neurolysis with phenol in abdominal wall cancer pain palliation.

نویسندگان

  • Rodolfo Gebhardt
  • Kenneth Wu
چکیده

Pain is commonly perceived by patients during cancer and its treatment. Although most patients respond to conservative management implemented according to the World Health Organization guidelines, a subset of patients with advanced disease develop intractable pain that may require additional interventions such as regional blocks and intrathecal therapy. Patients with terminal abdominal or pelvic cancer who have high tumor burdens are often offered a diagnostic visceral nerve block followed by neurolysis for pain palliation. Conventional visceral blocks usually require fluoroscopic guidance for correct needle placement in the vicinity of the neuroaxis or abdominal cavity. These techniques carry risks of injury to vessels, bowels, and nerves. Transversus abdominis plane (TAP) block is a technique that is easy to perform (particularly when ultrasonographic guidance is used), has a good safety record, and effectively reduces pain levels and opioid requirements after abdominal and gynecological surgery. Although numerous studies have demonstrated the effectiveness of TAP blocks in acute pain management, the role of TAP block in chronic pain management is very limited. We believe that chemical neurolysis with phenol can prolong the effects of analgesia in patients with terminal cancer. We describe a case of terminal abdominal sarcoma with intractable pain that responded well to a TAP block followed by TAP neurolysis. The patient tolerated the procedure well and demonstrated sustained analgesia for 45 days before dying of the disease. We also demonstrated that TAP block significantly reduces the total opioid requirement as demonstrated by the morphine equivalent daily dose score after the neurolytic procedure. This result supports our belief that TAP block with TAP neurolysis is an effective and inexpensive modality that can be used to palliate intractable abdominal wall pain in patients with terminal abdominal cancer.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Neurolytic transversus abdominal plane block with alcohol for long-term malignancy related pain control.

There have been several case reports in the literature of neurolytic transversus abdominis plane (TAP) blocks being used for malignant abdominal wall pain. However, most used phenol as a neurolytic agent. We found only a single case report by Sakamoto using alcohol for TAP neurolysis. Unfortunately this patient passed away only 5 days after performance of the block. We attempt to extend upon th...

متن کامل

Transversus abdominis plane block anesthesia in abdominoplasties.

BACKGROUND The transversus abdominis plane block is a promising approach to the provision of postoperative analgesia following abdominal incision. This effective method blocks the sensory nerve supply to the anterior abdominal wall. The authors evaluated its analgesic efficacy over the first 12 postoperative hours after abdominoplasty with liposculpture in a randomized, controlled, double-blind...

متن کامل

Transversus abdominis plane block following abdominally based breast reconstruction: study protocol for a randomized controlled trial

BACKGROUND Breast reconstruction using the free muscle-sparing transversus abdominus myocutaneous or deep inferior epigastric perforator flaps are common methods for restoring mastectomy defects for breast cancer patients. Despite its increasing popularity and safety, the abdominal donor site remains a major source of postoperative pain. Conventional postoperative pain relief protocol consists ...

متن کامل

Ultrasound-guided continuous oblique subcostal transversus abdominis plane blockade: description of anatomy and clinical technique.

BACKGROUND Recently, ultrasound-guided transversus abdominis plane blockade for abdominal wall analgesia has been described, and it involves injection of local anesthetic into the transversus abdominis plane. The posterior approach involves injection of local anesthetic in the lateral abdominal wall between the costal margin and the iliac crest and is suitable for postoperative analgesia after ...

متن کامل

Treatment Option for Refractory Postherpetic Neuralgia – Transversus Abdominis Plane (TAP) Block: Two Case Reports

Postherpetic neuralgia (PHN) is a severe neuropathic pain syndrome. The treatment of PHN is complex and refractory in some patients. We present two cases with refractory anterior abdominal wall pain due to PHN that were successfully treated with transversus abdominis plane (TAP) block. The TAP block seems to be an alternative for patients with PHN who suffer from anterior abdominal wall pain ac...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Pain physician

دوره 16 3  شماره 

صفحات  -

تاریخ انتشار 2013