|
Intercostal nerve blockade for cancer pain: effectiveness and selection of patients
Frank CS Wong, TW Lee, KK Yuen, SH Lo, WK Sze, Stewart Y Tung
Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong
Kong
OBJECTIVES. To review treatment results of intercostal nerve blockade at our
centre and those reported in the literature, and to determine
which patients benefit most from this procedure.
DESIGN. Retrospective study.
SETTING. Regional palliative care centre in a regional hospital in Hong
Kong.
PATIENTS. Oncology patients who had intercostal nerve blockade at
Tuen Mun Hospital from 1995 to 2005 were divided into three
groups: (1) those who appeared not to tolerate opioids; (2) those
deemed to have inadequate pain control, despite high doses of
analgesics; and (3) those referred to avoid early use of high-dose
opioids and tolerance.
MAIN OUTCOME MEASURES. The effectiveness and complications of intercostal nerve
blockade, and the extent of benefit derived from intercostal
nerve blockade in different patient groups.
RESULTS. This study found that 80% of the 25 patients noted optimal
local pain control and 56% experienced reduction in analgesic
use after intercostal nerve blockade. About 32% did not notice
recurrence of the targeted pain till the end of their lives. None
of the patients developed pneumothorax. Most benefit from
intercostal nerve blocks were derived by group 2 patients, 90%
of whom obtained optimal local pain control (P=0.23) and
enjoyed a significant reduction in analgesics use (P=0.019), and
in 40% their target pain was controlled till the end of life. Only
about one third of group 3 patients had subsequent reduction
in use of analgesics, mainly because they had co-existing pain
other than at the target selected for treatment. Half (50%) of
group 1 patients achieved optimal pain control.
CONCLUSION. Our treatment results from intercostal nerve blockade are
comparable to those reported in the literature. The procedure is
safe if closely monitored. Good selection of cases is important for
optimising the therapeutic gain. The largest benefit is obtained
in patients who have inadequate pain control after high-dose
morphine.
Hong Kong Med J 2007;13:266-70
Key words: Anesthesia, local; Intercostal nerves;
Nerve block; Pain clinics; Palliative care
|
