Invasive Techniques for Pain Management in Palliative Care: A Single Center Experience

To achieve a successful pain control, interventional techniques are required in approximately 15% of the patients admitted to the Palliative Care Service (PCS). Objectives: To evaluate the frequency and effectiveness of the invasive procedures performed in the PCS of our health area. Other matters studied included complications associated with these procedures, the effects on morphine consumption, and functional status, survival rate, as well as the type and location of pain. Methods: A descriptive, observational, retrospective study was performed between January 2009 and December 2011. Patients included were considered difficult to manage and required the assistance of the PCS of the University Hospital La Paz (Madrid). Results: Patients were divided into 3 groups according to the technique used: sympathetic blocks (group S), epidural catheters (group C), and series of plexus, peripheral nerve, or epidural infiltrations (group I). Ninety-four procedures in 45 patients were performed (3.6% of patients admitted by the PCS). The average mean value of pain intensity before and after procedures decreased significantly (8.6 vs. 3.1, respectively, P < 0.01). The need for strong opioids was reduced (275.5 mg/day previously and 212.8 mg/day after the technique, P < 0.01). The overall complication rate was 16%. Conclusion: The analgesic efficacy of these techniques has been adequate in all groups. Patients who required epidural catheters had a higher rate of complications.