Neurolytic celiac plexus block reduces occurrence and duration of terminal delirium in patients with pancreatic cancer

• Published in: Journal of anesthesia 2013-02, Vol.27 (1), p.88-92
• Main Authors: Arai, Young-Chang P., Nishihara, Makoto, Kobayashi, Kunio, Kanazawa, Tamotsu, Hayashi, Nobuhiko, Tohyama, Yukio, Nishida, Kikuyo, Arakawa, Maki, Suzuki, Chiharu, Kinoshita, Akiko, Kondo, Miki, Matsubara, Satuki, Yokoe, Nami, Hayashi, Ruiko, Ohta, Aya, Sato, Jun, Ushida, Takahiro
• Format: Article
• Language: English
• Subjects: Aged; Anesthesiology; Care and treatment; Celiac Plexus; Critical Care Medicine; Delirium; Delirium - etiology; Delirium - prevention & control; Delirium - psychology; Emergency Medicine; Female; Humans; Hypotension - etiology; Intensive; Karnofsky Performance Status; Male; Medicine; Medicine & Public Health; Middle Aged; Nerve Block - adverse effects; Nerve Block - methods; Original Article; Pain Measurement; Pain Medicine; Pain, Intractable - drug therapy; Pain, Intractable - etiology; Pain, Intractable - therapy; Palliative Care; Pancreatic cancer; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - psychology; Physiological aspects; Surgery, Computer-Assisted; Terminal Care; Tomography, X-Ray Computed
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-012-1486-3

Purpose WHO’s three step ladder sometimes cannot provide adequate pain relief for pancreatic cancer. Some patients develop terminal delirium (TD). The aim of this study was to test if the addition of a celiac plexus block (CPB) to pharmacotherapy could reduce the incidence of TD. Methods Pancreatic cancer patients under the care of our palliative-care team were investigated with regard to the duration and occurrence of TD, pain scores [numerical rating score (NRS)] and daily opioid dose. Between August 2007 to September 2008, 17 patients received only pharmacotherapy (control group). Then, we modified our guideline for analgesia, performing CPB 7 days after the first intervention of our team. Between October 2008 to September 2009, 19 patients received CPB. Results The opioid doses in CPB group were significantly lower both at 10 days after the first intervention (3 days after CPB) (27 ± 11 vs. 66 ± 82 mg; p  = 0.029) and 2 days before death (37 ± 25 vs. 124 ± 117 mg; p  = 0.009). NRS in the CPB group were significantly lower both at 10 days after the first intervention (0 [0–2] vs. 3 [2–5], p