Decrease of postneurolytic pain in patients with advanced pancreatic cancer after paravertebral neurolytic block

Zemskov S.1, Dronov O.1, Ramazanov V.2

S. Zemskov1, O. Dronov1, V. Ramazanov2

1Bogomolets National Medical University, General Surgery #1, Kyiv, Ukraine

2Hospital of Ministry of Internal Affairs, Anesthesiology Department, Kyiv, Ukraine

szemskov@yahoo.com

Introduction: More than 60% of advanced pancreatic cancer (APC) patients suffer from resistant pain syndrome whether they were previously resected or not. One of effective and minimal invasive pain control techniques is paravertebral neurolytic block (PNB). The most frequent adverse effect of PNB is postneurolytic pain (PP) persisting up to 7 days and more after the procedure. Aim: To decrease PP in the patients after PNB and to study the effectiveness of PNB in combination with prolonged ropivacaine epidural infusion (PREI) in APC patients. Patients and Methods: Group I consisted of 21 sequential patients matched to inclusion criteria and treated by PNB in our clinic before we have started PREI application in postneurolytic period. Group II consisted of 21 sequential patients matched to inclusion criteria and treated with PNB and PREI. Neural roots were identified at Th5–Th10 level by rhythmic eliciting paresthesia and/or pain radiating to corresponding body segment according to frequency of Stimuplex® DIG electrostimulation after puncture. 0.2% ropivacaine was used for PREI. Numeric Pain Rating Scale (NPRS) from 0 to 10 and morphine equivalent dose (MED) for tramadol daily intake were used for evaluation of pain. The study protocol was approved by Ethical Committee permission of Bogomolets National Medical University (Kyiv, Ukraine). Results: Pain assessment in postneurolytic period is represented in Table. Average duration of PREI application was 6.4 ± 1.3 days. 14 patients from group I and 11 patients from group II completely refused opioids. No severe side effects of PREI as pronounced arterial hypotension or paresis of lower extremities were recorded.

Table. Pain assessment in patients with advanced pancreatic cancer.
Patients Initial level Day 3rd after PNB Day 7th after PNB
NPRS MED NPRS MED NPRS MED
Group I 7.11±0.23 38.20±0.90 8.44±1.21 54.60±5.30 4.85±0.86 15.70±2.40
Group II 6.98±0.29 39.10±1.20 3.73±0.45 12.40±0.80 3.96±0.58 14.90±1.90
p value >0.05 >0.05 <0.05 <0.05 >0.05 >0.05

Conclusion: PREI application significantly reduces PP in early postneurolytic period. PNB in combination with PREI is effective and safe technique to reduce pain and improve quality of life in APC patients.

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