ABSTRACT
Neurolytic sympathetic plexus block (NSPB) has been proposed to prevent the development of pain and improve the quality of life of patients with cancer, thus questioning the WHO protocol that proposes the use of invasive methods only as a final resort. This study evaluates the pain relief, opioid consumption and quality of life provided by the use of NSPB in two different phases of cancer pain and compares them with that provided by pharmacological therapy only. Sixty patients with abdominal or pelvic cancer pain were divided into three groups and observed for 8 weeks. In group I, neurolytic celiac (NCPB) or superior hypogastric plexus block (SHPB), or lumbar sympathetic ganglion chain block (LSGCB) was performed with alcohol in patients using NSAID and a weak oral opioid or morphine (dose/=4. In group II, NCPB, SHPB or LSGCB were performed on patients using NSAID and morphine (dose>/=90 mg/day) and reporting VAS>/=4. The patients of group III received pharmacological therapy only. The patients of groups I and II had a significant reduction of pain (P < 0.004), opioid consumption (P < 0.02) and a better quality of life (P < 0.006) than those of group III, but no significant differences between groups I and II were seen in these aspects. Opioid-related adverse effects were significantly greater in group III (P < 0.05). The occasional neurolysis-related complications were transitory. The results suggest NSPB for the management of cancer pain should be considered earlier in the disease.
Subject(s)
Abdominal Neoplasms/complications , Autonomic Nerve Block/methods , Pain Management , Pelvic Neoplasms/complications , Adult , Aged , Celiac Plexus , Constipation/etiology , Constipation/therapy , Diarrhea/etiology , Diarrhea/therapy , Female , Ganglia, Sympathetic , Humans , Hypogastric Plexus , Male , Middle Aged , Morphine/therapeutic use , Narcotics/therapeutic use , Nausea/etiology , Nausea/therapy , Pain/etiology , Pain/physiopathology , Pain Measurement/methods , Quality of Life , Surveys and Questionnaires , Time Factors , Vomiting/etiology , Vomiting/therapyABSTRACT
STUDY OBJECTIVES: To examine analgesia and adverse effects following transdermal application of nitroglycerine (a nitric oxide generator) combined with oral morphine, in cancer pain patients. DESIGN: Randomized, double-blind study. SETTING: Teaching hospital. PATIENTS: 36 patients suffering from cancer pain. INTERVENTIONS: Patients were divided into two groups (n = 18). All patients were regularly taking oral amitriptyline 50 mg at bedtime. Pain was evaluated using a 10-cm visual analog scale (VAS). The morphine regimen was individually adjusted to a maximal oral dose of 80 to 90 mg/day, to maintain the VAS score less than 4/10 cm. When patients complained of pain (VAS equal or greater than 4/10), despite taking 80 to 90 mg of oral morphine daily, the transdermal test drug was supplemented as follows: the control group received a placebo patch daily, and the nitroglycerine group received a 5-mg/24-hour nitroglycerine patch daily. Patients were free to manipulate their daily morphine consumption at the time the test drug was administered, to keep VAS less than 4/10 cm. After the introduction of the transdermal test drug, patients were evaluated by the staff on a weekly basis as outpatients, over four consecutive weeks. MEASUREMENTS AND MAIN RESULTS: The groups were similar in respect to demographic data and VAS pain scores before the treatment. The daily consumption of oral morphine was smaller in the nitroglycerine group compared with the control group after the 14th day of evaluation (p < 0.002). Patients from the control group in general complained of somnolence, compared with the nitroglycerine group. CONCLUSION: Transdermal nitroglycerine was an effective coadjuvant analgesic. In conjunction with its opioid tolerance sparing function, delivery of nitric oxide donors together with opioids may be of significant benefit in cancer pain management in delaying morphine tolerance and decreasing the incidence of adverse effects related to high doses of opioids.
Subject(s)
Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Nitric Oxide Donors/administration & dosage , Nitroglycerin/administration & dosage , Pain/drug therapy , Administration, Cutaneous , Administration, Oral , Analgesics, Opioid/adverse effects , Double-Blind Method , Drug Synergism , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Morphine/adverse effects , Neoplasms/complications , Pain/etiology , Pain Measurement , Prospective StudiesABSTRACT
Justificativa e objetivos: a literatura relata que a induçäo inalatória única de altas doses de sevoflurano está associada com alta incidência de complicaçöes, como tosse, laringoespamo, parada respiratória, obstruçäo de vias aéreas, excesso de secreçäo, excitaçäo e tremores. Este trabalho visou avaliar a induçäo inalatória através do aumento gradativo da concentraçäo do sevoflurano em pacientes adultos, com o intuito de comparar com os dados da literatura. A manutençäo e repercussöes no pós-operatório foram também avaliada. Método: fizeram parte do estudo 35 pacientes (16-42 anos) submetidas à laparoscopia para procedimentos ginecológicos. A medicaçäo pré-anestésica constou de midazolam (0,05mg.kg(elevado a menos um) por via venosa. Após a administraçäo venosa de alfentanil 25µg.kg(elevado a menos um), a induçäo inalatória foi feita com doses crescentes de sevoflurano asssociado ao oxigênio a 100 por cento (aumento de 1 por cento a cada inspiraçäo profunda). Após a perda do reflexo corneano foi repetido alfentanil (25µg.kg(elevado a menos um) por via venosa e a intubaçäo orotraqueal foi facilitada pelo atracúrio (0,5mg.kg(elevado a menos um). A manutençäo foi realizada com oxigênio e sevoflurano suficiente para manter os níveis pressóreos ñ 15 por cento abaixo dos valores iniciais. Foram avaliados o tempo para perda do reflexo corneano, efeitos adversos na induçäo, tempo para extubaçäo desde o desligamento do sevoflurano, tempo para alta hospitalar, analgesia e efeitos adversos no período pós-operatório. Resultados: a perda do reflexo corneano ocorreu entre a segunda e a quinta inspiraçäo profunda em todas as pacientes (1,5ñ0,8 minutos) e a concentraçäo média de sevoflurano utilizada durante a induçäo enalatória foi 3,5 ñ 0,7 por cento. Quatroze por cento as pacientes apresentaram tosse ou certa agitaçäo que cedeu com o aumento da concentraçäo de sevoflurano. As pacientes permaneceram estáveis durante o período per-operatório. O tempo desde o desligamento do sevoflurano até extubaçäo foi de 5,7 ñ 2,3 minutos. No período pós-operatório uma das pcientes apresentou náusea à retirada do tubo orotraqueal e outra peciente apresentou náusea e vômitos durante 120 minutos na recuperaçäo pós-operatória, tendo recebido 20mg de metoclopramida e 8mg de ondansetron por via venosa, O tempo médio para alta da sala de recuperaçäo pós-anestésica foi de 90 ñ 28 minutos. Conclusöes: o aumento gradativo da concentraçäo de sevoflurano resultou em maior tempo de induçäo...
Subject(s)
Humans , Female , Adolescent , Adult , Anesthetics, Inhalation/administration & dosage , Methyl Ethers/pharmacology , Gynecologic Surgical Procedures , LaparoscopyABSTRACT
We evaluated postoperative pain relief and incidence of side effects of the combination of epidural morphine (0.5 mg) and sublingual nifedipine (10 mg). Thirty-six patients were submitted to elective operations and divided into 4 groups receiving placebo (groups A and B) or morphine (groups C and D) by the epidural route, followed by sublingual placebo (groups A and C) or nifedipine (groups B and D) administered in a double-blind fashion. The mean (+/- S.E.M.) periods of analgesia were 16.6 +/- 1.6 (A), 15 (B) 105 +/- 77.0 (C), and 428.8 +/- 72.0 (D) min. No patient had pruritus, excessive sedation or respiratory depression. Episodes of nausea and/or vomiting requiring no specific therapy were observed in groups A, B and D. Nifedipine-treated groups also had a significant fall in blood pressure which was controlled by rehydration. These results indicate that epidural morphine-induced postoperative pain relief may be enhanced by systemic administration of nifedipine, with easily controlled side effects.
