Topic D: TREATMENT APPROACHES (MEDICAL/INTERVENTIONAL)
566
D07 CANCER PAIN – OTHER
564
SUPERIOR HYPOGASTRIC BLOCK: TRANSDISCAL VERSUS
CLASSIC POSTERIOR APPROACH IN PELVIC CANCER PAIN
G.G. Ali1 ° , M.K. Helaly1 , Y.M. Labib2 . 1 Anesthesia and Algology Dep.,
National Cancer Institute, Cairo, 2 Anesthesiology Dep., Cairo University,
Cairo, Egypt
The classic posterior approach of superior hypogastric block has several
technical difficulties. The transdiscal approach is a novel and easier
approach for superior hypogastric which overcome these technical diffi-
culties. Thirty patients complaining from severe pelvic pain due to cancer
were randomly allocated into two groups: Transdiscal group and Classic
group. VAS pain scores, daily morphine consumption, patient satisfaction,
number of needle puncture attempts, duration of the procedure and side
effects were recorded.
The duration of the procedure was significantly decreased in the transdiscal
group (24.4±5.6 min) compared to the classic group (57.9±9.8 min).
There were no significant differences between the two groups in daily
morphine consumption and VAS pain scores. Patient satisfaction increased
significantly in the transdiscal group versus the classic group at 24 h, one
week and one month after the block, P < 0.05. There was no discitis, disc
rupture or herniation in the transdiscal group.
We can conclude that the transdiscal approach for superior hypogastric
plexus block in pelvic cancer pain is easier, safer, more effective with less
side effects than the classic approach.
565
PREVALENCE OF CANCER PAIN IN THE NETHERLANDS
M.H.J. van den Beuken1 , J.M. de Rijke1 ° ,
A.G. Kessels1 ,
H.C. Schouten2 ,
M. van Kleef1 , J. Patijn1 . 1 Pain Management and Research Centre,
Dept of Anaesthesiology, University Hospital Maastricht, University
Maastricht, 2 Dept of Oncology, University Hospital Maastricht,
University Maastricht, The Netherlands
Background and Aim: Pain is one of the most feared symptoms in cancer
patients and is considered to be a major problem. Due to methodological
flaws and small sample sizes, the magnitude of the problem is far from
clear. Our aim was to investigate the prevalence of pain in patients with
cancer in a province of the Netherlands.
Methods: All cancer patients visiting the outpatient’s clinics of 5 hospitals
and 2 radiotherapy centres were approached during two weeks in the period
November 2004-June 2005. Patients not receiving treatment were recruited
via general practitioners, hospices and nursing homes. Data were collected
by means of questionnaires on demographics, tumour characteristics,
treatment, medication and pain (Brief Pain Inventory).
Results: 1429 patients consented to participate (response 75%). 52% were
female. Mean age was 63 years. The prevalence of pain was 55% in the
total study population. Of the patients >6 months after curative treatment
(n = 385) 24% had moderate to severe pain (NRS > 4), prevalence was
20% in patients under/after curative treatment <6 months ago (n = 388),
24% in patients receiving palliative anti-cancer treatment (n = 575) and
53% in patients with terminal disease (n = 81). Highest prevalence rates
were found in patients with lung (32%) and haematological cancer other
than (non)-Hodgkin lymphoma (38%). Pain management was insufficient
in 42% of the patients.
Conclusion: Prevalence of cancer pain was high in all disease groups.
With the increasing number of people living to older ages, reducing the
prevalence of pain at any stage of cancer is of paramount importance.
S149
SUPERIOR HYPOGASTRIC PLEXUS BLOCK: TRANSDISCAL
APPROACH VERSUS CLASSIC POSTERIOR APPROACH IN
PELVIC CANCER PAIN
G.G. El-Sayed ° , M.A. Helaly, Y.M. Labib. Anesthesiology and Algology
Department, National Cancer Institute, Cairo, Egypt
Background and Aims: The classic posterior approach of superior hy-
pogastric block has several technical difficulties. The transdiscal approach
is a novel and easier approach for superior hypogastric which overcome
these technical difficulties. The aim of this study is to compare the two
approaches.
Methods: Thirty patients were randomly allocated into two groups:
Transdiscal group and Classic group, VAS pain scores, daily morphine
consumption, duration of the procedure and side effects were recorded.
Results: The duration of the procedure was significantly decreased in
the transdiscal group (24.4±5.6 min) compared to the classic group
(57.9±9.8 min). There was no significant differences between the two
groups in daily morphine consumption and VAS pain scores. There was
no discitis, disc rupture or herniation in the transdiscal group.
Conclusion: The transdiscal approach for superior hypogastric plexus
block in pelvic cancer pain is easier, safer, more effective with less side
effects than the classic approach.
567
INTRATHECAL MAGNESIUM SULFATE IN CANCER PAIN AS
AN ADJUVANT TO MORPHINE
F. Kahraman ° . Anesthesiology and Reanimation Department, Trabzon
Numune State Hospital, Trabzon, Turkey
Background and Aims: The case report presents a patint with intact
lower limb function. Although intrathecal 6 mg/day morphine was aplied,
the VAS (Visual Analog Score) remained at 7−8/10. Since intact motor
functions, the patient rejected neurolysis treatment. Intrathecal ketamine
(preservative free) has been used as an adjuvant to morphine in cancer
patients. Magnesim sulfate an NMDA receptor antagonist like ketamin is
also used in spinal anesthesia with local anesthetics in humans. We decided
to use both ketamine and magnesium sulfate intrathecally as adjuvants to
morphine in this patint.
Methods: Our patient was a 50-years-old male with rectum cancer for
5 years. Because of metastases to urinary bladder and ureters, renal
function was absent. Pain complaint was especially localized to the
lower abdominal and sacrococcygeal region. Initially, intrathecal morphine
dosage was 0.2 mg×6/day with adequate pain relief but increased gradually
to 0.6 mg×10/day with insisting VAS score of 7−8/10. We prepared a 1.5%
magnesium sulfate and 0.05% ketamine mixture. We applied 4cc of this
mixture (60 mg magnesium sulfate and 2 mg ketamine) to the patient by
an intrathecal port.
Results: A Prompt decrease of VAS to 3−4/10 was observed. There was no
motor block or severe hypotension. We continued this dosage 2−3times a
day. Morphine requirement decreased to 0.2−0.4×2−3/day. We maintained
this treatment for 2 months until the patient expired.
Conclusion: Magnesium sulfate may be useful as an adjuvant to morphine
intrathecally in unbearable cancer pain although further research is neded.
568
COMPLEX REGIONAL PAIN SYNDROME AFTER SUBCLAVIAN
ARTERIAL GRAFTING: A CASE REPORT
E. Teyin1 ° , N. Karahan1 , G. Arar1 , M. Aksun1 , U. Özgürbüz1 ,
U. Yetkin2 , A. Gürbüz2 . 1 Department of Anaesthesiology and
Reanimation, 2 Department of Cardiovascular Surgery, Ataturk Training
and Research Hospital, Izmir, Turkey
A 50 years old woman had a modified radical mastectomy due to invasive
ductal carcinoma and went under chemotherapy and radiotherapy. Five
years after therapy, right subclavian arter occlusion was developed and
treatment was not successfull despite grafting. Additional investigations