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Interventional Palliative therapy Tools of the Trade

Interventional Palliative therapy Tools of the Trade. Plexus Blocks Splanchnic & Sympathetic. Somatic Denervation. Neuraxial Drug Delivery. Nonmalignant Pain . Plexus Blocks. Celiac Plexus . Pancreas Liver Biliary System Omentum Mesentery. Needle Placement For Celiac Plexus Block.

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Interventional Palliative therapy Tools of the Trade

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  1. Interventional Palliative therapy Tools of the Trade

  2. Plexus Blocks Splanchnic & Sympathetic Somatic Denervation Neuraxial Drug Delivery Nonmalignant Pain

  3. Plexus Blocks

  4. Celiac Plexus Pancreas Liver Biliary System Omentum Mesentery

  5. Needle Placement For Celiac Plexus Block

  6. Classic Transcural Needle Placement

  7. Celiac Plexus Block Transaortic Technique

  8. Hypogastric Plexus Pelvic organs – Bladder – Prostate - Rectum

  9. Advantages Anatomic specific analgesia Relatively Long Lasting Can be repeated Trial Injection can be performed To establish efficacy Studies suggest increased quality Of life even if narcotic use unchanged

  10. Disadvantages Complications of Procedure Discomfort

  11. Somatic Nerves

  12. Hypobaric Technique -absolute alcohol-

  13. Hyperbaric Technique -phenol-

  14. Hyperbaric Intrathecal Neurolysis- Phenol

  15. Epidural Neurolysis

  16. Advantages Anatomically specific analgesia Precise localization Potential for permanent pain relief Multiple lesioning modalities

  17. Disadvantages Lesioning can be painful Risk of neuroma/neuritis Risk of motor or functional deficit(s) depending on Technique and contiguous structures

  18. Peripheral Nerve Blocks

  19. Neuraxial Drug Administration

  20. Indications Life expectancy > 3 months Systemic pain control with narcotics but side effects intolerable Pain from primary or metastatic bone pain

  21. Anesth Analg. 2011 Mar;112(3):558-67. Epub 2010 Dec 14. The novel role of the mu opioid receptor in lung cancer progression: a laboratory investigation. Opioid Gene Variants Linked To Cancer Survival in Women ISSUE: December 2011Mounting laboratory and epidemiologic data have suggested a link between exposure to opioids during cancer surgery and metastasis of, and eventual death from, the disease. Now, a major genetics study has turned up some of the most compelling evidence yet for a connection between opioids and malignancy, even beyond the operating room. Direct effect of morphine on breast cancer cell function in vitro: role of the NET1 gene

  22. Intrathecal Systems Direct CSF drug delivery Catheter tip occlusion rare Single drug or synergistic therapy Rostral Spread

  23. Epidural Implants Segmental Allows more aggressive use of local anesthetics Reactive scarring at catheter tip Causing pain and occlusion Useful for trial and pain control can allow systemic narcotic withdrawal

  24. Infusion Techniques Narcotics Morphine- hydrophilic Hydromorphone/Fentanyl- lipophilic Local anesthetics Clonidine Prialt Compounding

  25. Interventions have higher success rate early in pain therapy- not as last resort Often useful in combination with narcotic & adjuvant therapy Remember not all pain is malignant pain

  26. ?

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