Tei, Y., Morita, T., Nakaho, T., Takigawa, C., Higuchi, A., Suga, A., . . . Fujimoto, M. (2008). Treatment efficacy of neural blockade in specialized palliative care services in Japan: A multicenter audit survey. Journal of Pain and Symptom Management, 36(5), 461–467.

To ascertain the frequency of neural blockade in certified palliative care units and by palliative care teams; to determine the efficacy of neural blockade interventions and explore the predictors of successful interventions

Co-researchers from 120 certified palliative care units and 20 palliative care teams reported on all patients who received neural blockade for pain control 2002–2003.

• The sample was composed of 136 patients. Authors studied 162 neural blockade interventions.
• Mean patient age was 59 years.
• Of all patients, 37% were female and 63% were male.
• Patients were adults with cancer who required neural blockade to manage pain refractory to standard pharmacologic management. Of all patients, 47 patients (35%) had colon or rectal cancer, 19 (14%) had uterine or ovarian cancer, 18 (13%) had pancreatic cancer. (Authors provide additional diagnoses.) Eight patients underwent two neural blockade procedures. Four patients underwent three procedures. Procedures included epidural nerve block with local anesthetics and/or opioids, neurolytic sympathetic plexus block, and intrathecal nerve block with phenol.

• Multisite
• Japan

Retrospective chart review

• Support Team Assessment Schedule
• Eastern Cooperative Oncology Group (ECOG) Performance Status Communication Capacity Scale (originally a validated five-item observer-rating scale), to quantify communication capacity in terminally ill patients (The scale includes ratings 0–3, with 0 or 1 indicating that the patient can achieve clear communication of complex or simple content.)
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, to grade grading delirium

All types of neural blockade studied—epidural, plexus, and intrathecal—were associated with reduction in pain intensity, improvement in performance status, and decrease in opioid consumption. No type was associated with significant improvement in communication level or decrease in delirium. Groups receiving plexus block or epidural experienced an improvement in performance status. Patients in the epidural and intrathecal groups reduced use of opiods, but patients in the plexus block group did not.

Of patients receiving palliative care services in Japan, 3.8% required neural blockade for pain control. The percentage is similar in Western countries. Study findings suggest that neural blockade can decrease pain intensity, improve performance status, and decrease opioid consumption, without causing serious adverse effects. Of 19 patients who had a neural blockade, six showed a decrease in delirium.

• This study was a retrospective chart review. Though researchers used a standardized data-collection sheet, not all charts may have included all the data requested.
• Data related to communication level and delirium were not collected in terms of metabolic or progressive disease symptoms. This practice would have aided assessment of change related to these two factors.
• Participating institutions were selected on the basis of convenience.
• Long-term efficacy was beyond the intent of the study.
• No patients received intrathecal opioid therapy, which was not a common practice in Japan at the time of the study.

Neural blockade may be a useful intervention for a select group of patients who are receiving inadequate pain control from traditional opioids.