Interventional pain management in cancer patients: Experience from tertiary care center of India

Abstract

20739 Background: Oral medication of WHO ladder is a gold standard and the mainstay of cancer pain management. It gives pain relief in 85–90% cases. In remaining 10–15% patients, physicians keep on fighting to give adequate pain relief.Interventional pain management techniques could be a very good alternative option for such patients. The key requirement for successful nerve block is to ensure optimal distribution of local anesthetic around nerve and plexus structures. The recent use of ultrasound imaging for nerve localization is an innovative application of an old technology, which addresses many of the shortcomings of current techniques. Methods: This article describes five years of experience of using diferent interventional pain management technique used on patients not relieved by oral medication at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences New Delhi. Results: Total number of patients that received interventional block (=215). Mandibular nerve block (=100), Coeliac plexus block (=26), Hypogastric plexus block (=22), Stellate ganglion block (=20), Occipital nerve block (=12), Gloosopharyngeal nerve block (=12), Supraorbital nerve block (=10), Sciatic nerve block (=12), Lumber chemical sympathectomy (=1). Out of the total 215 patients, 184 patients received block either under nerve stimulator guidance, CT guidance or under C- arm guidance. The failure rate ranged from 5–20% with inadequate level of nerve block. Ultrasound guided nerve block has improved quality of nerve block with success rate varying from 95–100%. Complications such as damage to neural structure and intravascular injections are nil. Conclusions: Although in near future routine use of this ultrasound technology for nerve blocks is not possible in most of the centers in India as this technique is quite nascent, require costly equipment and needs advance training, however, authors believe that any technology that can make the procedure better, safer and faster for both the patients and doctors then it must be adopted. No significant financial relationships to disclose.