title: Invasive techniques for pain management in palliative care: a single center experience.
abstract: To achieve a successful pain control, interventional techniques are required in approximately 15% of the patients admitted to the Palliative Care Service (PCS).
  
  
  OBJECTIVE
  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%.
  
  
  CONCLUSIONS
  The analgesic efficacy of these techniques has been adequate in all groups. Patients who required epidural catheters had a higher rate of complications.
authors: Pain Unit, Department of Obstetric Anesthesia, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Enrique
authors: E
authors: Canser
authors: Pain Unit, Department of Obstetric Anesthesia, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Blanca
authors: B
authors: Martínez-Serrano
authors: Pain Unit, Department of Obstetric Anesthesia, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Azahara
authors: A
authors: Sancho
authors: Palliative Care Service, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Alberto
authors: A
authors: Alonso-Babarro
authors: Palliative Care Service, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Yolanda
authors: Y
authors: Vilches
authors: Pain Unit, Department of Obstetric Anesthesia, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Eduardo
authors: E
authors: Alonso-Yanci
authors: Pain Unit, Department of Obstetric Anesthesia, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Elena
authors: E
authors: Gredilla
authors: Pain Unit, Department of Obstetric Anesthesia, Hospital Universitario La Paz, Madrid Autónoma University, Madrid, Spain.
authors: Fernando
authors: F
authors: Gilsanz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy; D059408:Pain Management / Q000009:adverse effects* / Q000379:methods*; D010147:Pain Measurement / Q000009:adverse effects / Q000379:methods*; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D009020:Morphine
keywords: end of life; nerve block; pain; palliative care