RESUMO
A subcostal transversus abdominis plane (TAP) phenol injection was performed on a patient with refractory cancer pain due a metastatic involvement of the abdominal wall. A diagnostic block with local anesthetic was performed under ultrasound guidance (USG), resulting in a decrease of 80% and 100% in dynamic and static visual analog scale (VAS) for pain, respectively, for 20 hours. A phenol injection was then performed under USG. The patient reported 70% and 100% reduction in the dynamic and static VAS for pain and had a 50% decrease in the opioid requirement that was maintained for 2 months. TAP blocks offer an interesting tool for either diagnosis or therapeutic purpose in chronic pain management. USG provides an optimal approach to soft-tissue lesions where fluoroscopy techniques are not useful.
Assuntos
Neoplasias Abdominais/complicações , Dor Abdominal/tratamento farmacológico , Carcinoma/complicações , Fenol/uso terapêutico , Neoplasias Abdominais/secundário , Dor Abdominal/etiologia , Parede Abdominal , Carcinoma/secundário , Feminino , Humanos , Pessoa de Meia-Idade , Fenol/administração & dosagem , Resultado do Tratamento , Neoplasias do Colo do Útero/patologiaAssuntos
Humanos , Anestesia por Condução/métodos , Doenças do Sistema Nervoso/induzido quimicamente , Nervos Periféricos , Anestesia por Condução/normas , Anestésicos Locais/efeitos adversos , Injeções Espinhais , Síndromes Neurotóxicas , Guias de Prática Clínica como Assunto , Canal Medular , Nervos Espinhais , UltrassonografiaRESUMO
Las fracturas vertebrales por compresión son de alta prevalencia y se relacionan principalmente a osteoporosis y cáncer. Frecuentemente tienen consecuencias devastadoras en la calidad de vida de los pacientes. Aquellos pacientes que no responden al tratamiento conservador se pueden beneficiar de una técnica mínimamente invasiva, la vertebroplastía, para reforzar la vértebra fracturada con cemento y así controlar el dolor. La vertebroplastía es un procedimiento ambulatorio con baja tasa de efectos colaterales cuando la realiza un médico con experiencia y el entrenamiento adecuado. Su tasa de éxito va del 65 al 95 por ciento, dependiendo de la indicación. Sólida evidencia científica se requiere aún para apoyar su amplio uso clínico.
Vertebral compression fractures are highly prevalent. Osteoporosis and cancer are the main causes. As a consequence patients endure excruciating breakthrough pain and debilitating experience that affect their quality of life. Those individuals that do not respond to classic treatment might benefit of vertebral cement augmentation. This is a totally ambulatory procedure aimed to control pain and stabilize the bone. Percutaneous approach is usually undertaken. Long lasting pain relief results in 65 to 95 percent of patients with a very low profile of complications when the procedure is done by experienced practitioners. Randomized, blinded and prospective studies are still required.