Q: 52 year old male with a known diagnosis of metastatic pancreatic cancer is transferred from oncology floor after requiring intubation due to narcotic overdose. This is the second time patient required intubation due to the similar reason. Which of the following is a good option to relieve pain and prevent further such episodes?
A) Celiac plexus neurolysis (CPN)
B) Request patient to sign Do Not Resuscitate (DNR) papers
C) Tracheostomy
D) Placement of a stent across the area of biliary tract obstruction
E) Gabapentin
Answer: A
Celiac plexus neurolysis (CPN) has been found to be more effective than any other modality to relieve pain from metastatic pancreatic cancer. Other closest option is local radiation. It should be understood that CPN is not a denervation process, rather it inhibits synaptic pathways within the plexus.
Choice B is unethical.
Choice C will not bring any comfort from pain.
Choice D may provide relief from pruritis and jaundice but not from pain.
Choice E may help but not be very effective in this scenario.
#palliativecare
#ethics
References:
1. Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 2004; 291:1092.
2. Amr YM, Makharita MY. Neurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study. J Pain Symptom Manage 2014; 48:944.
A) Celiac plexus neurolysis (CPN)
B) Request patient to sign Do Not Resuscitate (DNR) papers
C) Tracheostomy
D) Placement of a stent across the area of biliary tract obstruction
E) Gabapentin
Answer: A
Celiac plexus neurolysis (CPN) has been found to be more effective than any other modality to relieve pain from metastatic pancreatic cancer. Other closest option is local radiation. It should be understood that CPN is not a denervation process, rather it inhibits synaptic pathways within the plexus.
Choice B is unethical.
Choice C will not bring any comfort from pain.
Choice D may provide relief from pruritis and jaundice but not from pain.
Choice E may help but not be very effective in this scenario.
#palliativecare
#ethics
References:
1. Wong GY, Schroeder DR, Carns PE, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 2004; 291:1092.
2. Amr YM, Makharita MY. Neurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study. J Pain Symptom Manage 2014; 48:944.
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