RESUMO
Resumen: La Asociación Mexicana para el Estudio y Tratamiento del Dolor nació en la década de los ochenta. Desde su fundación ha intervenido activamente en la educación continua de la nación y ha colaborado en la elaboración de documentos gubernamentales sobre diversos tópicos. En esta ocasión, durante la tercera reunión de delegados y vocales, se ponen a consideración diversas recomendaciones generales en materia de educación y regulación de opioides.
Abstract: The Mexican Association for the Study and Treatment of Pain was born in the eighties. Since its foundation, it has actively participated in the continuing education of the Nation and has collaborated in the preparation of government documents on various subjects. On this occasion, during the third meeting of delegates and members, various general recommendations regarding education and regulation of opioids are put for consideration.
RESUMO
BACKGROUND: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. MATERIALS AND METHODS: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction. RESULTS: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed. CONCLUSIONS: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications.
