Cross-sectional study to evaluate patients' medication management with a new model of care: incorporating a pharmacist into a community specialist palliative care telehealth service.

BACKGROUND: Patients receiving palliative care are often on complex medication regimes to manage their symptoms and comorbidities and at high risk of medication-related problems. The aim of this cross-sectional study was to evaluate the involvement of a pharmacist to an existing community specialist palliative care telehealth service on patients' medication management. METHOD: The specialist palliative care pharmacist attended two palliative care telehealth sessions per week over a six-month period (October 2020 to March 2021). Attendance was allocated based on funding received. Data collected from the medication management reviews included prevalence of polypharmacy, number of inappropriate medication according to the Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy criteria (STOPP/FRAIL) and recommendations on deprescribing, symptom control and medication management. RESULTS: In total 95 patients participated in the pharmaceutical telehealth service with a mean age of 75.2 years (SD 10.67). Whilst 81 (85.3%) patients had a cancer diagnosis, 14 (14.7%) had a non-cancer diagnosis. At referral, 84 (88.4%, SD 4.57) patients were taking ≥ 5 medications with 51 (53.7%, SD 5.03) taking ≥ 10 medications. According to STOPP/FRAIL criteria, 142 potentially inappropriate medications were taken by 54 (56.8%) patients, with a mean of 2.6 (SD 1.16) inappropriate medications per person. Overall, 142 recommendations were accepted from the pharmaceutical medication management review including 49 (34.5%) related to deprescribing, 20 (14.0%) to medication-related problems, 35 (24.7%) to symptom management and 38 (26.8%) to medication administration. CONCLUSION: This study provided evidence regarding the value of including a pharmacist in palliative care telehealth services. Input from the pharmacist resulted in improved symptom management of community palliative care patients and their overall medication management.

The Impact of Health Equity-Informed Eligibility Criteria to Increase the Delivery of Pharmacist-Delivered Comprehensive Medication Management Services for Patients with High Blood Pressure.

OBJECTIVE: Evaluate a cardiovascular care intervention intended to increase access to comprehensive medication management (CMM) pharmacy care and improve vascular health goals among socially disadvantaged patients. DESIGN: Retrospective electronic health records-based evaluation. SETTING: Thirteen health care clinics serving socially vulnerable neighborhoods within a large health system. PARTICIPANTS: Hypertensive and hyperlipidemic adult patients. INTERVENTION: CMM pharmacists increased recruitment among patients who met clinical criteria in clinics serving more diverse and socially vulnerable communities. CMM pharmacists partnered with patients to work toward meeting health goals through medication management and lifestyle modification. MAIN OUTCOME MEASURES: Changes in the engagement of socially disadvantaged patients between preintervention and intervention time periods; vascular health goals (ie, controlled blood pressure, appropriate statin and aspirin therapies, and tobacco nonuse); and the use of health system resources by CMM care group. RESULTS: The intervention indicated an overall shift in sociodemographics among patients receiving CMM care (fewer non-Hispanic Whites: N = 1988, 55.81% vs N = 2264, 59.97%, P < .001; greater place-based social vulnerability: N = 1354, 38.01% vs N = 1309, 34.68%, P = .03; more patients requiring interpreters: N = 776, 21.79% vs N = 698, 18.49%, P < .001) compared to the preintervention period. Among patients meeting intervention criteria, those who partnered with CMM pharmacists (N = 439) were more likely to connect with system resources (social work: N = 47, 10.71% vs 163, 3.74%, P < .001; medical specialists: N = 249, 56.72% vs N = 1989, 45.66%; P < .001) compared to those without CMM care (N = 4356). Intervention patients who partnered with CMM pharmacists were also more likely to meet blood pressure (N = 357, 81.32% vs N = 3317, 76.15%, P < .001) and statin goals (N = 397, 90.43% vs N = 3509, 80.56%, P < .001) compared to non-CMM patients. CONCLUSIONS: The demographics of patients receiving CMM became more diverse with the intervention, indicating improved access to CMM pharmacists. Cultivating relationships among patients with greater social disadvantage and cardiovascular disease and CMM pharmacists may improve health outcomes and connect patients to essential resources, thus potentially improving long-term cardiovascular outcomes.

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization: Payer Status and Medication Management-Part Six of the Movement Is Life Special ONJ Series.

This article is the sixth in the Movement is Life series and focuses on insurance coverage and medication management in the perioperative period, 2 tangentially related variables that affect patient outcomes. Our aim is to use current practices and literature to develop recommendations for nurse navigators' execution of preoperative optimization protocols related to payer status and medication management. Discussions with nurse navigators and a literature search were used to gather information and develop recommendations specific to optimizing payer status and medication management. Nurse navigators connected patients to resources and provided education regarding financial concerns and medications, and findings from the literature discussed insurance status among TJA patients. Nurse navigators can contribute to payer status and medication management optimization by providing patient education and resource referrals. In addition, we recommend conducting repeated medication reconciliation and developing awareness of financial resources and perioperative medication management guidelines.

Enhancing drug therapy in ostomy patients: Best practice recommendations for medication management.

BACKGROUND: Ostomy surgery is a common procedure that poses various challenges for patients and healthcare professionals. There are numerous guidelines addressing different ostomy-related problems (ORPs) and supporting an interdisciplinary approach for ostomy care, but evidence-based literature for optimizing drug therapy after ostomy surgery is lacking. AIM: To investigate and characterize typical ORPs in relation to drug therapy and provide best practice recommendations from a pharmaceutical point of view. METHODS: Patients with an ileo- or colostomy were consecutively enrolled in a prospective, interventional monocentric cohort study during hospitalization, with particular attention to medication. A clinical pharmacist assessed DRPs by performing level 3 medication reviews and patient interviews. Pharmacists' interventions (PIs) were evaluated by two senior clinical pharmacists and documented in DokuPIK (Documentation of Pharmacists' Interventions in the Hospital). Following interdisciplinary discussions, physicians either accepted or rejected the proposed changes in drug therapy. Comparisons were made between ileostomy and colostomy patients regarding type and extent of PIs. RESULTS: Out of the 80 patients included in the cohort, 54 (67.5%) had an ileostomy and 26 (32.5%) a colostomy. In this study, 288 PIs were documented (234 ileostomy vs. 54 colostomy), of wich 94.0% were accepted and implemented by the physicians. The most common reason for PIs in both subgroups (29.6% ileostomy vs. 26.1% colostomy) was a missing drug although indicated (e.g. no loperamide, but high stoma output). The proportion of PIs associated with the ostomy was higher in ileostomy patients (48.3% ileostomy vs. 31.5% colostomy; p = 0.025). Typical ORPs were extracted and analyzed as case studies including recommendations for their respective management and prevention. CONCLUSION: This study highlights the importance of clinical pharmacists being a part of interdisciplinary teams to collaboratively improve ostomy care and patient safety. Especially ileostomy patients are more vulnerable for ORPs in the context of drug therapy and need to be monitored carefully.

A survey on the implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting.

BACKGROUND: Polypharmacy is common in chronic medication users, which increases the risk of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the Netherlands in 2012, but the effectiveness might be hindered by limited implementation in community pharmacies. Therefore our aim was to describe the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation. METHODS: An online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likert-scale answering options. It was sent out to all Dutch community pharmacies (n = 1,953) in January 2021. Descriptive statistics were used. RESULTS: A total of 289 (14.8%) community pharmacies filled out the questionnaire. Most of the pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely do in practice. CONCLUSIONS: Lack of time and suboptimal collaboration with medical specialists are the most important barriers to the implementation of CMRs.

Drug-Related Problems and Recommendations Made during Home Medicines Reviews for Sick Day Medication Management in Australia.

Backgrounds and Objectives: Using certain medications during an intercurrent illness can increase the risk of drug related problems (DRP) occurring such as acute kidney injury (AKI). Medications that increase this risk include sulfonylureas, angiotensin converting enzyme inhibitors, diuretics, metformin, angiotensin receptor blockers, non-steroidal anti-inflammatories drugs, and sodium glucose co-transporter 2 inhibitors (SADMANS). Sick day medication guidance (SDMG) recommends withholding SADMANS medications during an intercurrent illness where adequate fluid intake cannot be maintained. But uptake of these recommendations is poor, and it is not known whether Australian pharmacists currently provide these recommendations during home medicine reviews (HMR) as per SDMG. We aimed to gain an understanding of the characteristics of DRP identified by pharmacists during HMR, especially those relating to SADMANS medications. Materials and Methods: We conducted a retrospective audit of 201 randomly selected HMR reports, conducted by accredited pharmacists from 2020 to 2022, that were analysed in 2023. All DRP and recommendations were categorised using a modified DOCUMENT system. Results: Overall, over 98% of participants experienced a DRP and a total of 710 DRP were found, where participants experienced an average of 4.0 ± 2.0 DRP each. Non-SADMANS medications accounted for 83.1% of all DRPs, with nervous system medications contributing the most. Common problems seen in non-SADMANS medications were related to toxicity, over/underdosing and undertreating. Diuretics contributed most to DRP in SADMANS medications. Problems with SADMANS were mainly related to toxicity and contraindications. No pharmacists provided SDMG despite 71.1% of participants using at least one SADMANS medication. Conclusions: We conclude that DRP remain prevalent in community pharmacy settings. Sick day recommendations were not provided in the HMRs included in our study, possibly due to lack of pharmacist knowledge and awareness. To ensure best practice, more research should be conducted to determine pharmacists' knowledge of and barriers to provision of sick day recommendations.

Improving Medication Management for Inpatients with a Secondary Diagnosis of Parkinson Disease.

ABSTRACT: Patients who have Parkinson disease require individualized medication regimens to optimize care. A review of the medication management of patients admitted to a tertiary care hospital with a secondary diagnosis of Parkinson disease found significant departures from the patients' home regimen. Medication regimens are often altered by health care teams unfamiliar with Parkinson disease-specific care in order to conform to standard hospital medication orders and administration times, potentially resulting in increased patient falls, delirium, and mortality.A nurse-led multidisciplinary team consisting of pharmacy, nursing, informatics, neurology, and quality personnel implemented a quality improvement (QI) project between July 2020 and July 2022 to identify patients with Parkinson disease, including those with a secondary diagnosis and those undergoing deep brain stimulation, and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. The QI project team also evaluated patient satisfaction with medication management.Among patients with a secondary diagnosis of Parkinson disease, the proportion who had medication histories conducted by a pharmacy staff member increased from a baseline of 53% to more than 75% per month. For all patients with Parkinson disease, those whose medication history was taken by a pharmacy staff member had orders matching their home regimen 89% of the time, whereas those who did not had orders matching the home regimen only 40% of the time. Among patients with a secondary diagnosis of Parkinson disease, the length-of-stay index decreased from a baseline of 1 to 0.94 and observed-to-expected mortality decreased from 1.03 to 0.78. The proportion of patients experiencing a fall decreased from an average of 5% to 4.08% per quarter, while the proportion of patients experiencing a fall with harm decreased from an average of 1% to 0.75% per quarter. The rate of 30-day readmissions decreased from 10.81% to 4.53% per quarter. Patient satisfaction scores were 1.95 points higher for patients who had medication histories taken by pharmacy than for those who did not (5 versus 3.05).

Administração segura de medicamentos via endovenosa: uma proposta para o hospital universitário / Safe intravenous drug administration: a proposal for the university hospital

Introdução: A assistência à saúde com qualidade e segurança é um tema atual e pertinente aos serviços de saúde, que tem se preocupado em aprimorar seus processos com base nos preceitos desta temática. Este estudo visa contribuir para qualidade e segurança na assistência aos pacientes no que concerne a administração de medicamentos. E também pretende contribuir com o ensino e pesquisa nesta área na medida em que trata um delineamento da realidade de uma Instituição de Ensino e busca propor uma uniformização do processo. Objetivos: Identificar a dinâmica de administração de medicamentos. Elaborar um Procedimento Operacional Padrão para administração de medicamentos via endovenosa. Elaborar Lista de Verificação (CheckList) com as etapas a serem seguidas para uma administração segura de medicamentos para avaliar adesão dos profissionais. Os produtos oriundos dessa pesquisa foram: Procedimento Operacional Padrão para administração de medicamentos via endovenosa e um CheckList com as etapas para administração segura de medicamentos.Método:Estudo descritivo com abordagem qualitativa para análise dos dados. Os participantes foram os membros da Equipe de Enfermagem da enfermaria de escolha, a coleta de dados foi realizada por meio da observação direta guiada por um roteiro de observação, no segundo semestre de 2015, de segunda a domingo, nos três turnos de trabalho após a assinatura do Termo de Consentimento Livre e Esclarecido, sendo a amostra não probabilística por conveniência. Este estudo foi aprovado pelo comitê de ética das instituições proponente e co-participante sob os pareceres n° 1.262.690 e 1.301.318. Resultados: Foi observado um total de 23 doses de medicamentos por via endovenosa. Foi observada adesão superior à 50% na maioria das etapas da administração de medicamentos. Porém ressaltou-se como pontos de atenção uma adesão de 17% ao uso de EPI durante a manipulação dos medicamentos, 17% à desinfecção das conexões antes da administração e 15% à higienização das mãos logo após o procedimento antes de retornar ao posto de enfermagem. Conclusão: Os achados desta pesquisa apontam para necessidade de intervenção em questões da prática dos profissionais como higienização das mãos e uso de EPI's. Esses dados corroboram a necessidade de uma uniformização da prática assistencial no que concerne a administração de medicamentos visando à qualidade e segurança da assistência de Enfermagem

Introduction: Health care with quality and safety is a current topic and pertinent to health services, which has been concerned with improving its processes based on the precepts of this theme. This study aims to contribute to quality and safety in patient care in drug administration. It also intends to contribute to teaching and research in this area insofar as it deals with a delineation of the reality of a teaching institution and seeks to propose a standardization of the process. Objectives: To identify the dynamics of drug administration. Elaborate a Standard Operating Procedure for intravenous drug administration. Elaborate Checklist with the steps to follow for safe administration of medications to assess adherence of professionals. The products that came from this research were: Standard Operating Procedure for intravenous drug administration and a CheckList with the steps for safe administration of drugs. Method: Descriptive study with qualitative approach for data analysis. Participants were members of the Nursing Team of the infirmary of choice, data collection was done through direct observation guided by an observation script, in the second half of 2015, from Monday to Sunday, in the three work shifts after the signature of the Free and Informed Consent Term, being the non-probabilistic sample for convenience. This study was approved by the ethics committee of the proposing institutions and co-participant under the reports no. 1,262,690 and 1,301,318. Results: A total of 23 intravenous drug doses were observed. Adherence was higher than 50% in most stages of drug administration. However, a 17% adherence to the use of PPE during the manipulation of medications, 17% to the disinfection of the connections before administration and 15% to the hygiene of the hands soon after the procedure before returning to the nursing station . Conclusion: The findings of this research point to the need for intervention in issues of professional practice such as hand hygiene and use of PPE. These data corroborate the need for a standardization of care practice regarding the administration of medicines aiming at the quality and safety of Nursing care

Nivel de conocimiento de las enfermeras acerca de la manipulación y administración parenteral de quimioterapia en pacientes hospitalizados en la Clínica Ricardo Palma 2012 / Level of knowledge of nurses about handling and parenteral administration of chemotherapy in patients hospitalized at the Clinical Ricardo Palma 2012

Objetivo: Determinar el nivel de conocimientos de las enfermeras acerca de la manipulación y administración parenteral de la quimioterapia en pacientes hospitalizados en la Clínica Ricardo Palma. Material y Método: El estudio fue de tipo cuantitativo, nivel aplicativo, método descriptivo, de corte transversal y prospectivo. La población estuvo conformada por 38 enfermeras(os) de los Servicios de Hospitalización durante los meses de julio a diciembre del 2012. Resultados: El nivel de conocimiento de las enfermeras(os) acerca de la manipulación y administración parenteral de la quimioterapia en los pacientes hospitalizados; del 100 por ciento (38), 73.7 por ciento (28) tienen un nivel de conocimiento medio, 15.8 por ciento (6) seguido de alto y 10.5 por ciento (4) es bajo. En la dimensión de la manipulación de la quimioterapia; 73.7 por ciento (28) es medio, 15.8 por ciento (6) seguido de alto y 10.5 por ciento (4) es bajo; y en la dimensión de la administración parenteral de la quimioterapia; 47.4 por ciento (18) es medio, 28.9 por ciento (11) seguido de alto y 23.7 por ciento (9) es bajo. Conclusiones: El nivel de conocimiento de las enfermeras(os) acerca de la manipulación y administración parenteral de la quimioterapia en pacientes hospitalizados de la Clínica Ricardo Palma es medio; en cuanto a la manipulación de citostáticos es medio porque pocos saben las medidas de protección al manipular los citostáticos; la forma de eliminarse los citostáticos; las formas de absorción a largo plazo; y el control periódico de la salud; y respecto a la administración porque pocos saben cómo es la preparación psicológica del paciente; las vías de administración de quimioterapia; el efecto secundario frecuente; y qué hacer cuando hay residuos de medicamentos de las infusiones.

Objective: To determine the level of knowledge of nurses about handling and parenteral administration of chemotherapy in patients hospitalized in the Clinical Ricardo Palma. Methods: The study was a quantitative, application level, descriptive method, cross-sectional and prospective. The sample consisted of 38 nurses of patient services during the months of July to December 2012. Results: The level of knowledge of nurses on handling and parenteral administration of chemotherapy in hospitalized patients, 100 per cent (38) 73.7 per cent (28) have an average knowledge level, 15.8 per cent (6) followed by high and 10.5 per cent (4) is low. In the dimension of the manipulation of chemotherapy, 73.7 per cent (28) is medium, 15.8 per cent (6) followed by high and 10.5 per cent (4) is low, and the dimension of the parenteral administration of chemotherapy; 47.4 per cent (18) is average, 28.9 per cent (11) followed by high and 23.7 per cent (9) is low. Conclusions: The level of knowledge of nurses on handling and parenteral administration of chemotherapy in inpatient Clinical Ricardo Palma is medium, in terms of handling cytostatics is medium because few know the protective measures to handling cytostatics, eliminated the form of cytostatics, forms of long-term absorption, and regular monitoring of health, and on the administration because few know how is the psychological preparation of the patient, the route of administration of chemotherapy; common side effect, and what to do when there are drug residues infusions.

Medication preparation and administration: analysis of inquiries and information by the nursing team / Preparación y administración de medicamentos: análisis de cuestionamientos e informaciones del equipo de enfermería / Preparo e administração de medicamentos: análise de questionamentos e informações da equipe de enfermagem

This study analyzed questions presented by nursing technicians and auxiliaries during medication preparation and administration. Data were collected through a form in which nurses who worked in the hospitalization unit of a general hospital in São Paulo, Brazil, were asked to take notes of any questions asked to them. Most of the 255 questions were related to medication dilution (103). Regarding the answers source, only 7.5 percent of answers were obtained from pharmaceutical professionals, 35.5 percent of the answers given by nurses was incorrect or partially correct, which can constitute a factor for medication administration errors. In addition, there are no pharmacists present in hospitalization units of Brazilian hospitals. These professionals could, jointly with nurses, facilitate medication orientation to nursing professionals during preparation and administration, as well as to patients themselves.

Este estudio analizó las preguntas presentadas por técnicos y auxiliares de enfermería a los enfermeros durante la preparación y administración de medicamentos. Para recopilar los datos, se utilizó un formulario entregue a los enfermeros de unidades de internación de un hospital general del interior del Estado de São Paulo, Brasil, solicitando que anotaran las dudas que recibieran. La mayoría de las 255 preguntas estaba relacionada a la disolución del medicamento (103). Respecto a las respuestas, solamente el 7,5 por ciento de estas fue obtenido a través de los profesionales de la farmacia. Se destaca que el 35,5 por ciento de las respuestas emitidas por los enfermeros estaban incorrectas o parcialmente correctas, lo que puede constituir un factor para errores en la administración de medicamentos. Además, no existen farmacéuticos en las unidades de internación en los hospitales brasileños. Estos podrían, en conjunto con los enfermeros, facilitar la orientación de los profesionales de enfermería en cuanto a los medicamentos, en el momento de su preparación y administración, y también de los propios pacientes.

Este estudo analisou os questionamentos apresentados por técnicos e auxiliares de enfermagem aos enfermeiros durante o preparo e administração de medicamentos. Para coleta dos dados utilizou-se um formulário entregue aos enfermeiros de unidades de internação de um hospital geral do interior paulista, solicitando que anotassem as dúvidas dos profissionais da equipe que lhe fossem endereçadas. Foram registrados pelos enfermeiros 255 questionamentos sendo que a maioria destes estava relacionada à diluição do medicamento (103). Com relação às respostas dos enfermeiros às dúvidas, somente 7,5 por cento destas foram obtidas através dos profissionais da farmácia. Ressalta-se que 35,5 por cento das respostas emitidas pelos enfermeiros estavam incorretas ou parcialmente corretas podendo constituir fator para erros na administração de medicamentos. Somado a isto, inexistem farmacêuticos nas unidades de internação nos hospitais brasileiros, os quais poderiam, juntamente com o enfermeiro, facilitar a orientação dos profissionais de enfermagem quanto aos medicamentos, no momento do preparo e administração dos mesmos, bem como ao próprio paciente.

Disponibilidad y uso de medicamentos antimaláricos en Bolivia / Availability and use of drugs im Bolivia antimaláricos

Pregunta de investigación ¿Como es la disponibilidad y el uso de los antimaláricos en Bolivia? Objetivos. Evaluar la disponibilidad y uso de los medicamentos antimaláricos en zonas endémicas de malaria de acuerdo a las normas nacionales. Métodos. Siguiendo los indicadores pre diseñados del manual de gestión farmaceutica de la malaria del management for Sciencies health (MSH). fue evaluada la disponibilidad de los antimaláricos revisando registros 2004-2005 de 21 establecimientos de salud de nivel I y II además de 4 almacenes regionales de los departamentos de Beni, Pando y Tarija y uno del nivel central (La Paz). Para evaluar el uso de los antimaláricos se utilizó la misma herramienta revisando 780 casos de malaria de los registros de tratamiento de pacientes con malaria no complicada atendidos durante el mismo periodo, tambien se observaron 156 atenciones a pacientes con malaria no complicada, habiendose entrevistado a 146 de ellos (93 por ciento) inmediatamente despues de recibir el tratamiento, asi como tambien se realizaron compras de antimaláricos en 28 farmacias privadas de los mismos departamentos. Resultados. El 76 por ciento (5/21) de los establecimientos evaluados no tienen registro de entrada y salida de medicamentos, la disponibilidad de medicamentos antimaláricos para malaria por P. vivax es del 100 por ciento, malaria no complicada por P.falciparum 53 por ciento, malaria y embarazo por P. falciparum 3 por ciento y malaria grave por P. falciparum 0 por ciento en los establecimientos de salud mientras que en los almacenes evaluados es el 90 por ciento, 25 por ciento, 25 por ciento y 38 por ciento respectivamente. los almacenes con mayor tiempo de desabastecimiento (365 días) fueron el de Riberalta y Guayaramerin para el artesunato,clindamicina y biclorhidrato ...

Research question How is it the availability and the use of antimalarial drugs in Bolivia?Objective Evaluate the availability and the use of antimalarial drugs in endemic areas of malaria according to the national norms.METHODS Following the indicator pre-designed in the manual of pharmaceutical management of the malaria of the Management for Sciences Health, the availability of the antimalarial drugs was evaluated revising the registers 2004-2005 of 21 health’s establishments level I and II and 4 regional depots of the Departments of Beni, Pando y Tarija. To...

O papel dos bloqueios anestésicos no tratamento da dor de origem cancerosa / Anesthetic blocks to treat cancer pain

JUSTIFICATIVA E OBJETIVOS: Tradicionalmente os anestesiologistas desenvolveram as técnicas de anestesia regional que hoje dominam. Para participarem do tratamento dos pacientes com dores crônicas, necessitam transferir os conhecimentos adquiridos, além das indicações cirúrgicas, indicando-os no momento correto, tornando-os úteis e eficazes, num atendimento que deve ser multidisciplinar. O objetivo deste trabalho é mostrar aos anestesiologistas que os bloqueios anestésicos, no tratamento da dor crônica de origem cancerosa, para serem úteis e eficazes, devem ser indicados no momento correto inserindo-os como parte de um tratamento sistêmico, do qual deve-se participar ativamente. CONTEUDO: O uso correto do protocolo da Organização Mundial da Saúde proporciona diretriz para o controle da dor na maioria dos pacientes com moléstia cancerosa avançada. A eficácia desta abordagem é demonstrada nos seus três primeiros passos, com pequeno número de complicações. Contudo, há pacientes que experimentam efeitos colaterais indesejáveis aos medicamentos opióides sistêmicos e a presença de metástases ósseas e as neuropatias podem determinar efeitos deletéricos nesses pacientes. Técnicas invasivas são raramente indicadas, mas podem resultar em analgesia no tratamento das dores resistentes aos opióides quando usados adequadamente. CONCLUSÕES: Bloqueios com agentes neurolíticos que exigiam alto grau de perícia dos anestesiologistas são as últimas opções de tratamento quando as drogas sistêmicas não mantêm o efeito desejado ou produzem efeitos colaterais de difícil tratamento. Bloqueios anestésicos e injeção de drogas opióides por via subaracnóidea, têm lugar de destaque no tratamento da dor de origem cancerosa e devem ser considerados em situações específicas como parte de um tratamento multidisciplinar.

BACKGROUND AND OBJECTIVES: Anesthesiologists have traditionally developed and mastered regional anesthetic techniques over the years. To help treating chronic pain, they need to transfer acquired know-how in addition to surgical indications, recommending procedures at the right time in a multidisciplinary approach. This research aimed at showing anesthesiologists that for anesthetic blocks to be useful and effective in treating chronic cancer pain, they have to be indicated in a timely manner, as part of a systemic approach where they need to play an active role. CONTENTS: WHO guidelines provide adequate pain control to most patients with advanced cancer disease. Its first three steps confirm the efficacy of this approach, with a low incidence of complications. There are however patients who experience undesirable side effects of systemic opioids, and the presence of bone metastases and neuropathies may determine noxious effects on those patients. Invasive techniques are seldom indicated, but they may provide analgesia in the treatment of opioid-resistant pain when adequately indicated. CONCLUSIONS: Neurolytic agent blocks, which require anesthesiologist skills, are the last treatment options when systemic drugs are unable to maintain desired effects or produce untreatable side effects. Anesthetic blocks and spinal opioids play an important role in the treatment of cancer pain and should be considered in specific situations as part of a multidisciplinary approach.

JUSTIFICATIVA Y OBJETIVOS: Tradicionalmente los anestesiologistas desarrollaron las técnicas regionales de anestesia que hoy dominan. Para participar del tratamiento de los pacientes con dolores crónicos, necesitan transferir los conocimientos adquiridos, además de las indicaciones quirúrgicas, indicándolos en el momento correcto, haciéndolos útiles y eficaces, a un atendimiento que debe ser multidisciplinar. El objetivo de este trabajo es mostrar a los anestesiologistas que los bloqueos anestésicos, en el tratamiento del dolor crónico de origen cancerosa, para que sean útiles y eficaces, deben ser indicados en el momento correcto, introduciéndolos como parte de un tratamiento sistémico, del cual se debe participar activamente. CONTENIDO: El uso correcto del protocolo de la Organización Mundial de la Salud proporciona orientación para el control del dolor en la mayoría de los pacientes con molestia cancerosa avanzada. La eficacia de este abordaje es demostrada en sus tres primeros pasos, con pequeño número de complicaciones. Con todo eso, hay pacientes que experimentan efectos colaterales indeseables a los medicamentos opioides sistémicos y a la presencia de metástases óseas y las neuropatias pueden determinar efectos deletéricos en esos pacientes. Técnicas invasivas son raramente indicadas, más pueden resultar en analgesia en el tratamiento de los dolores resistentes a los opioides, cuando usados adecuadamente. CONCLUSIONES: Bloqueos con agentes neurolíticos que exigían alto grado de pericia de los anestesiologistas son las últimas opciones de tratamiento cuando las drogas sistémicas no mantienen el efecto deseado o producen efectos colaterales de difícil tratamiento. Bloqueos anestésicos e inyección de drogas opioides por vía subaracnóidea tienen lugar de destaque en el tratamiento del dolor de origen canceroso y deben ser considerados en situaciones específicas como parte de un tratamiento multidisciplinar.