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Review of Coeliac Plexus Blockade for the Management of Chronic Pancreatitis Pain at Tallaght University Hospital (TUH)

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Pain Studies and Treatment 2022年第3期10卷 21-34页

作者： Paul Ryan Kevin C. Conlon Philip Hu Paul Ridgway Marie Egan camillus power Department of Anaesthesia Intensive Care and Pain Medicine Tallaght University Hospital Dublin Ireland Professorial Surgical Unit Department of Surgery Trinity College Dublin and Tallaght University Hospital Dublin Ireland Department of Surgery Trinity College Dublin and Tallaght University Hospital Dublin Ireland Department of Anaesthesia Intensive Care and Pain Medicine Trinity College Dublin and Tallaght University Hospital Dub-lin Ireland

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

关键词： Coeliac Plexus Block Chronic Pancreatitis Chronic Pain Opioid Analgesia Opioid Reduction

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Finding the Needle in the Haystack—An Unusual Case of Astasia-Abasia Following Sacro-Iliac Joint Injection for Chronic Low Back Pain

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Pain Studies and Treatment 2021年第1期9卷 1-6页

作者： Gurmukh Das Punshi Andrew Purcell camillus power Department of Anaesthesiology Critical Care and Pain Medicine Tallaght University Hospital Dublin Ireland

We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.

关键词： Chronic Low Back Pain Sacroiliac Joint Injection Dexamfetamine Astasia-Abasia

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Thermal Microcautery, a Form of Peripheral Nerve Field Stimulation for Treatment of Painful Knee Osteoarthritis: Non-Randomized Controlled Trial

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Pain Studies and Treatment 2019年第3期7卷 33-54页

作者： camillus K. power Deborah Galvin Tagarisa Foto Ahmed Abdelaal Ahmed Mahmoud Nikolaos G. Kostopoulos Department of Anesthesia Critical Care & Pain Medicine Tallaght University Hospital Dublin Ireland Department of Anaesthesia Beni-Suef University Hospital Beni-Suef Egypt Department of Anaesthesia Birmingham Children’s Hospital Birmingham UK Holistic Health Centre Athens Greece

Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful knee osteoarthritis (PKO). Methods: A non-randomized controlled trial was employed. All PKO patients on a waiting list for knee replacement were offered PNFS-TMC. Patients in the intervention group received 4 sessions (2 weeks apart) of PNFS-TMC by a pin-point tip of a metal rod. The rod was heated over a flame for 5 minutes before being used to induce a single 1 mm second-degree burn over points of tenderness. The control group was selected from the same waiting list. The primary outcome was assessed by Visual Analogue Scale (VAS) scores. The secondary outcomes were changes in levels of physical day to day activity, sleep and analgesics. Results: 16 PNFS-TMC intervention group patients and 15 control group patients were subject to analysis. Baseline VAS score was higher in PNFS-TMC group [9 ± 1.23 (95% CI 8.38 - 9.61) versus 5.93 ± 2.11 (95% CI 4.81 - 7.06) in the control, P Conclusions: PNFS-TMC could offer a simple, safe, cheap and effective method of pain management in chronic PKO patients.

关键词： Peripheral Nerve Field Stimulation Thermal Microcautery Painful Osteoarthritis Agni-Karma

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