Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat i...Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat intractable pain in patients with chronic pancreatitis. Aims: Our primary objective was to determine the effect of CPB for pain management in a cohort of patients with chronic pancreatitis. We also sought to quantify opioid use in patients with chronic pancreatitis. Methods: We reviewed the database of pain referrals for chronic pancreatitis and recorded opioid use for each patient. We interviewed all patients who underwent CPB for chronic pancreatitis at TUH from January 2018-December 2020. Effect of the block, duration of pain relief, analgesia requirements, complications and patient satisfaction were recorded. Results: 62 inpatient referrals were made to the pain service over a 3-year period regarding pain management in chronic pancreatitis. 76% of patients referred for chronic pancreatitis pain management require regular long-term opioids. Mean daily oxycodone requirement in this group was 52 mg. 11 of these patients underwent CPB over a 3-year period. Mean age of patients who underwent CPB was 44 years. Effective reduction in pain scores (>50% improvement) was achieved in 7 of 11 patients. The mean NRS pain score decreased from 9.2 (±0.9) to 4.4 (±3.1). Mean duration of pain relief experienced was 69 days. Transient diarrhoea was reported by 1 patient. 4 patients reported a temporary decrease in oral analgesia requirement, while 3 patients reported a sustained decrease in analgesia requirement post CPB. For those who had further CPBs, the effect of repeated interventions was comparable to the initial procedure. Conclusion: High regular opioid consumption is common in patients with chronic pancreatitis. CPB can provide significant improvement in pain control and quality of life in appropriately selected patients. CPB can assist with opioid reduction and containment. It is not effective in all cases and there is high inter-patient variability. The procedure has a good safety profile.展开更多
Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ES...Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ESP)block to improve pain control and minimize opioid usage in the postoperative setting.Materials and methods:At our institution,an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy.This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia.Patient charts were retro-spectively reviewed and placed into 2 cohorts:one cohort participated in the ERAS pathway,whereas the other received traditional pain control.The primary outcome evaluated was postoperative morphine equivalents received.Secondary outcomes included nursing pain scores,opioid prescriptions for home,and quality of life.Descriptive statistics were performed by nonparametric Mann-Whitney U andχ2 tests for continuous and categorical variables,respectively.Results:Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort.There was a statistically sig-nificant difference in average postoperative morphine equivalents received(17.0 vs.39.9,p<0.01)and average postoperative nursing pain score(2.4 vs.3.6,p<0.01).Fifty-three percent(32/60)of patients in the ERAS cohort received an opioid prescription for home compared with 80%(56/70)in the traditional cohort(p<0.01).There was no significant quality-of-life difference between the groups.No adverse patient events resulted from the block.Conclusions:An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores.Future randomized prospective studies with the ERAS protocol can be considered.展开更多
文摘Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat intractable pain in patients with chronic pancreatitis. Aims: Our primary objective was to determine the effect of CPB for pain management in a cohort of patients with chronic pancreatitis. We also sought to quantify opioid use in patients with chronic pancreatitis. Methods: We reviewed the database of pain referrals for chronic pancreatitis and recorded opioid use for each patient. We interviewed all patients who underwent CPB for chronic pancreatitis at TUH from January 2018-December 2020. Effect of the block, duration of pain relief, analgesia requirements, complications and patient satisfaction were recorded. Results: 62 inpatient referrals were made to the pain service over a 3-year period regarding pain management in chronic pancreatitis. 76% of patients referred for chronic pancreatitis pain management require regular long-term opioids. Mean daily oxycodone requirement in this group was 52 mg. 11 of these patients underwent CPB over a 3-year period. Mean age of patients who underwent CPB was 44 years. Effective reduction in pain scores (>50% improvement) was achieved in 7 of 11 patients. The mean NRS pain score decreased from 9.2 (±0.9) to 4.4 (±3.1). Mean duration of pain relief experienced was 69 days. Transient diarrhoea was reported by 1 patient. 4 patients reported a temporary decrease in oral analgesia requirement, while 3 patients reported a sustained decrease in analgesia requirement post CPB. For those who had further CPBs, the effect of repeated interventions was comparable to the initial procedure. Conclusion: High regular opioid consumption is common in patients with chronic pancreatitis. CPB can provide significant improvement in pain control and quality of life in appropriately selected patients. CPB can assist with opioid reduction and containment. It is not effective in all cases and there is high inter-patient variability. The procedure has a good safety profile.
文摘Background:There is no standard analgesic pathway after percutaneous nephrolithotomy.At our institution,an Enhanced Recovery After Surgery(ERAS)pathway was instated that included a preoperative erector spinae plane(ESP)block to improve pain control and minimize opioid usage in the postoperative setting.Materials and methods:At our institution,an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy.This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia.Patient charts were retro-spectively reviewed and placed into 2 cohorts:one cohort participated in the ERAS pathway,whereas the other received traditional pain control.The primary outcome evaluated was postoperative morphine equivalents received.Secondary outcomes included nursing pain scores,opioid prescriptions for home,and quality of life.Descriptive statistics were performed by nonparametric Mann-Whitney U andχ2 tests for continuous and categorical variables,respectively.Results:Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort.There was a statistically sig-nificant difference in average postoperative morphine equivalents received(17.0 vs.39.9,p<0.01)and average postoperative nursing pain score(2.4 vs.3.6,p<0.01).Fifty-three percent(32/60)of patients in the ERAS cohort received an opioid prescription for home compared with 80%(56/70)in the traditional cohort(p<0.01).There was no significant quality-of-life difference between the groups.No adverse patient events resulted from the block.Conclusions:An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores.Future randomized prospective studies with the ERAS protocol can be considered.
