Pulse Transit Time as a Predictor of the Efficacy of a Celiac Plexus Block in Patients With Chronic Intractable Abdominal Pain

被引:2
作者
Kim, Young Uk [1 ]
Kim, Doo Hwan [2 ]
Cheong, Yuseon [3 ]
Kong, Yu-Gyeong [2 ]
Lee, Jonghyuk [2 ]
Park, Soo Kyoung [1 ]
Karm, Myong-Hwan [2 ]
Suh, Jeong Hun [2 ]
机构
[1] Catholic Kwandong Univ Korea, Dept Anesthesiol & Pain Med, Coll Med, Int ST Marys Hosp, Inchon, South Korea
[2] Univ Ulsan, Dept Anesthesiol & Pain Med, Asan Med Ctr, Coll Med, 86 Asanbyungwon Gil, Seoul 138736, South Korea
[3] Kangwon Natl Univ Hosp, Dept Anesthesiol & Pain Med, Chunchon, South Korea
关键词
pulse transit time; celiac plexus block; visceral pain; sympathetic blockade; UNRESECTABLE PANCREATIC-CANCER; WAVE VELOCITY-MEASUREMENT; QUALITY-OF-LIFE; MANAGEMENT; NEUROLYSIS; DIFFERENCE; ANESTHESIA;
D O I
10.1097/AJP.0000000000000288
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective: There is no well-defined predictor of satisfactory pain relief after celiac plexus block (CPB) at the early stage of treatment. This study evaluated whether measurement of the electrocardiographic R-wave and the arrival time of the pulses at the toe pulse transit time (E-T PTT) can be an early predictor of pain response and success of CPB in patients with chronic intractable visceral pain. Methods: Twelve patients aged between 20 and 80 years who underwent CPB for treatment of chronic intractable cancer-related abdominal pain were included. A successful CPB was determined as a > 50% decrease on the numerical rating scale measured 24 hours after the procedure. The E-T PTT at baseline and at 5, 10, 20, and 30 minutes after the injection of local anesthetic was measured as the time between the R-wave on the electrocardiogram and the peak point of the corresponding plethysmogram wave from the ipsilateral great toe. The change in the E-T PTT that was predictive of a successful CPB was analyzed using receiver operating characteristic curve analysis. Results: A CPB was successful in 9 of 12 cases; the dE-T PTT5/E-T PTT0 of the success group was 6.84% +/- 5.04% versus 0.72% +/- 0.78% in the failure group (P = 0.021). The mean E-T PTTx differed significantly between timepoints (F = 9.313, P = 0.014) and between the success and failure groups (P < 0.01). The best value of dE-T PTT5/E-T PTT0 indicating a successful CPB, estimated by receiver operating characteristic curve analysis, was 2.30% (sensitivity 88.9%, specificity 100%). The area under the curve was 96% (95% confidence interval, 85.7%-100%). Conclusions: Prolongation of E-T PTT at 5 minutes after CPB correlates closely with a significant analgesic effect.
引用
收藏
页码:522 / 526
页数:5
相关论文
共 25 条
[1]   Comparative Study Between 2 Protocols for Management of Severe Pain in Patients With Unresectable Pancreatic Cancer One-Year Follow-Up [J].
Amr, Yasser M. ;
Makharita, Mohamed Y. .
CLINICAL JOURNAL OF PAIN, 2013, 29 (09) :807-813
[2]   The effect of celiac plexus block on heart rate variability [J].
Arai, Young-Chang P. ;
Morimoto, Atsuko ;
Sakurai, Hiroki ;
Ohmichi, Yusuke ;
Aono, Shuichi ;
Nishihara, Makoto ;
Sato, Jun ;
Ushida, Takahiro ;
Inoue, Shinsuke ;
Kurisuno, Makoto ;
Kobayashi, Yuji .
JOURNAL OF ANESTHESIA, 2013, 27 (01) :62-65
[3]  
Arcidiacono PG, 2011, COCHRANE DB SYST REV, V16
[4]   ASSESSMENT OF ARTERIAL DISTENSIBILITY BY AUTOMATIC PULSE-WAVE VELOCITY-MEASUREMENT - VALIDATION AND CLINICAL-APPLICATION STUDIES [J].
ASMAR, R ;
BENETOS, A ;
TOPOUCHIAN, J ;
LAURENT, P ;
PANNIER, B ;
BRISAC, AM ;
TARGET, R ;
LEVY, BI .
HYPERTENSION, 1995, 26 (03) :485-490
[5]   Increase in pulse transit time to the foot after epidural anaesthesia treatment [J].
Babchenko, A ;
Davidson, E ;
Adler, D ;
Ginosar, Y ;
Kurz, V ;
Nitzan, M .
MEDICAL & BIOLOGICAL ENGINEERING & COMPUTING, 2000, 38 (06) :674-679
[6]   Celiac Plexus Block and Neurolysis for Pancreatic Cancer [J].
Bahn, Bret M. ;
Erdek, Michael A. .
CURRENT PAIN AND HEADACHE REPORTS, 2013, 17 (02)
[7]   Celiac plexus block for visceral pain [J].
Carroll I. .
Current Pain and Headache Reports, 2006, 10 (1) :20-25
[8]   The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain [J].
de Oliveira, R ;
dos Reis, MP ;
Prado, WA .
PAIN, 2004, 110 (1-2) :400-408
[9]   Pain management in chronic pancreatitis: taming the beast [J].
Enweluzo, Chijioke ;
Tlhabano, Letlhogonolo .
CLINICAL AND EXPERIMENTAL GASTROENTEROLOGY, 2013, 6 :167-171
[10]   Assessment of Celiac Plexus Block and Neurolysis Outcomes and Technique in the Management of Refractory Visceral Cancer Pain [J].
Erdek, Michael A. ;
Halpert, Daniel E. ;
Fernandez, Marlis Gonzalez ;
Cohen, Steven P. .
PAIN MEDICINE, 2010, 11 (01) :92-100