Friday, November 17, 2006

Endoscopic celiac plexus blocks; California law; antibiotics in the dying; breakthrough pain

I am traveling for the next week and may not post again until after Thanksgiving. I know a couple of weeks ago I promised/threatened a Pallimed format update--that is still forthcoming but I'm not sure when it will be (it has to do with Blogspot/Blogger's software update which is being rolled out in bits & pieces). However, when it does happen, it looks like we will have tags and labels, making searching/sorting the blog much easier (we now have 255 posts). It will also make the comment spammers that much happier; up until now I have been able to manually remove most of their ads for "Vico-profen" & requests to "come visit [their] website--I think you'll like it!" Hopefully I'll be able to keep this up.

I'm going to try to unload a few from my large back-log before the holiday...

1)
The Journal of Supportive Oncology has a case series on using endoscopic ultrasound to guide celiac plexus blocks. It's mostly just a general discussion of the technique & the actual case series is little more than a hand-waving 'this seemed to be helpful for most of our patients.' While I'm happy that this relatively new technique is out there, the best study ever of CPB was not a resounding endorsement of the practice. The same issue has an interesting review of hypovolemia in the cancer patient.

2)
The IAHPC website has a brief summary of the new California controlled substances act which appears to be very reasonable and supportive of using controlled substances for analgesia. This summary is all I know about this.

3)
A recent European Journal of Cancer Care has an article examining antibiotic use in dying cancer patients (free full-text here). It's a case series looking at antibiotic prescribing patterns in cancer patients admitted to a single hospital in South Korea for terminal care (mean duration of stay prior to death was 30 days). Not too much can be gleaned from the study other than antibiotic use was very common (84%--this number exceeded the percentage of patients for whom there was documented suspicion of infection). Similar to a previous study I blogged most patients didn't appear to have symptom relief (although, again, this wasn't a prospective study designed to look at symptom relief so who really knows). This area, along with the role of thromboembolism prophylaxis in similar patient populations (& I'm sure a few others), remains nearly a blank when it comes to quality research to guide us as to what, if anything, we should be doing on behalf of our patients. One can make arguments about what makes sense, of course, but what makes sense is often wrong when examined empirically.

4)
The Journal of Pain recently had an article on the prevalance and characteristics of breakthrough pain in chronic non-cancer pain patients. This was a motley group of 228 patients with a wide variety of pain syndromes who were all on opioids with relatively stable pain control. 3/4 of them however had 'severe' episodes of breakthrough pain, a median of two of them a day, and which lasted on average ~60 minutes.


Happy Thanksgiving

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