servicios profesionales de anestesiología y medicina del dolor centro médico del noroeste tijuana...
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Servicios Profesionales de Anestesiología yMedicina del Dolor
Centro Médico del NoroesteTijuana BC, México
V. Whizar-Lugo, F. Anzorena-Vallarino, R. Estrada-Coronado,C. Solar-Labastida, C. Segovia-García, J. Saldaña-Huerta
ONE NEEDLE TRANS-AORTIC AND RETROCRURAL NEUROLYTIC CELIAC ONE NEEDLE TRANS-AORTIC AND RETROCRURAL NEUROLYTIC CELIAC PLEXUS BLOCK FOR SEVERE UPPER ABDOMINAL CANCER PAINPLEXUS BLOCK FOR SEVERE UPPER ABDOMINAL CANCER PAIN
One One Needle,Trans-aortic and RetrocruralNeedle,Trans-aortic and RetrocruralCeliac Plexus NeurolysisCeliac Plexus NeurolysisAim of the study
• To investigate the usefulness of a single needle injection for a pre-aortic and retrocrural CPN in opioid resistant cancer pain patients, who have anatomy distortion
• To determine the pre-crural and retro-crural neurolytic spread
• To determine side effects and complications of this technique
Anatomy and Neurolytic Agent Diffusion
Celiac plexus neurolysis techniquesAccording with anatomical approaches
POSTERIOR APPROACH Retrocrural, Trans-crural, and Trans-aortic
ANTERIOR APPROACHTrans-gastric and Trans-hepatic
RETROCRURAL Standard
Two needless with posterior approach
PRECRURALPosterior approach
Trans-aorticTrans-crural
Anterior approachTrans-hepaticTrans-gastric
RETRO and PRECRURALPosterior approach
One needle technique
Celiac plexus neurolysis techniquesAccording with neddle placement
Analgesia (VAS) and % Opiod Reduction
R e s u l t s
Patients Type of cancer Pain (VAS) % opioid reduction
Follow-up
No Age Sex Initial Final Months
12 51.8 M 11 / F1 Pancreas 8.7±0.9 2.5±0.9 76.25% 1 - 12
2 50.5 M 1 / F1 Liver 8.0 2.0 97.5% 3 - 7
2 39 M 1 / F1 Gastric limphoma
9.0 2.0 77.5% 5 - 8
2 47.5 M 1 / F1 Stomach 9.0 2.0 95.0% 1 - 7
TOTAL 18
M 14 / 2 9.0±0.89 2.3±0.9 80.8% 1 - 12
Patients Pain (VAS) Cancer % opioid reduction
Follow-up
No Age Sex inicial final Months Dead
1 58 M 10 1 Pancreas 85 4 -
2 70 M 8 2 Pancreas 50 6 +
3 58 F 9 3 Stomach 90 7 +
4 35 M 10 2 Gastric limphoma 85 5 -
5 42 M 8 2 Pancreas 100 1 -
6 53 M 8 3 Liver 95 3 +
7 62 F 10 4 Pancreas 0 2 +
8 37 M 9 1 Stomach 100 1 -
9 55 M 8 3 Pancreas 90 4 -
10 43 M 10 3 Pancreas 90 8 +
11 51 M 9 3 Pancreas 100 3 -
12 39 M 9 2 Pancreas 80 4 +
13 48 F 8 1 Liver 100 7 +
14 52 M 8 3 Pancreas 70 4 +
15 39 M 9 3 Pancreas 80 7 +
16 43 F 8 2 Gastric limphoma 70 8 -
17 59 M 7 1 Pancreas 100 5 +
18 52 M 9 3 Pancreas 70 12 -
C o m p l i c a t i o n sC o m p l i c a t i o n s
MinorLocal pain n= 5 (-%)
Transitory diarrhea n= 4 (-%)
Arterial hypotension n= 2 (-%)
Severe none
TRANS-AORTIC AND RETROCRURALTRANS-AORTIC AND RETROCRURAL
C o n c l u s i o n s
1.This technique is usefull in patients with opioid resistant/side effects upper abdominal cancer pain, who have anatomy distortion
2. It is a safe, and easy procedure
3.No neuro-vascular complications were seen
4.Satisfactory analgesia was achieved
5.Total opioid intake was reduced
ONE NEEDLE CELIAC PLEXUS NEUROLYSIS