REGULAR CONTENT
Final ID
518
Type
Original Scientific Research-Oral or Pos
Authors
B March1, D Sella2, R Paz-Fumagalli3, S Clendenen1, A Kalava4
Institutions
1Mayo Clinic, Jacksonville, FL, 2Mayo Clinic Florida, Jacksonville, FL, 3N/A, Ponte Vedra Beach, FL, 4Tampa General Hospital, Tampa, FL
Purpose
Patients with amyotrophic lateral sclerosis (ALS) are at risk for respiratory complications when sedated for painful procedures. Until recently in our practice PRG in ALS was done with local anesthetic alone without sedation, but patients had substantial post-procedural pain. Recently, regional anesthesia using bilateral T6-T8 paravertebral nerve block (PVB) was adopted to reduce patient discomfort, anxiety and potential respiratory complications. We review our experience with PRG in ALS before and after the introduction of PVB.
Materials & Methods
A retrospective review of medical records was performed to identify patients with ALS that underwent PRG over a 14 year period. Demographic data, procedural details and post-procedure progress were tabulated. For the PVB group 24 hour pain score, analgesic use, sleep quality and overall analgesic satisfaction were prospectively collected.
Results
181 patients with ALS that underwent PRG were identified. The complication rate for the entire cohort was 30% (54/181), including severe pain (24/54) that required analgesic escalation or re-admission (none in the PVB group, p=0.36), perioperative tube dysfunction (13/54), stoma site infection (8/54), and minor bleeding (3/54). 30-day mortality was 7% (1 pneumonia possibly related to periprocedural aspiration). Of the 10 patients that received PVB the pain scores were mostly 0-2 (range 0-7), 4 experienced transient hypotension during the block, 8/10 reported good or very good sleep quality, all reported good, very good or excellent satisfaction with analgesia, and oral analgesic use was minimal (only 7 tablets of hydrocodone total between 10 patients within 24 hours).
Conclusions
PRG is safe in patients with ALS whether done with or without PVB. Analgesic escalation and re-admission were more likely in the non-PVB group but did not reach statistical significance, likely because the PVB group was small. With PVB oral analgesic use was minimal; sleep quality and overall analgesia were satisfactory in most PVB cases.
Final ID
518
Type
Original Scientific Research-Oral or Pos
Authors
B March1, D Sella2, R Paz-Fumagalli3, S Clendenen1, A Kalava4
Institutions
1Mayo Clinic, Jacksonville, FL, 2Mayo Clinic Florida, Jacksonville, FL, 3N/A, Ponte Vedra Beach, FL, 4Tampa General Hospital, Tampa, FL
Purpose
Patients with amyotrophic lateral sclerosis (ALS) are at risk for respiratory complications when sedated for painful procedures. Until recently in our practice PRG in ALS was done with local anesthetic alone without sedation, but patients had substantial post-procedural pain. Recently, regional anesthesia using bilateral T6-T8 paravertebral nerve block (PVB) was adopted to reduce patient discomfort, anxiety and potential respiratory complications. We review our experience with PRG in ALS before and after the introduction of PVB.
Materials & Methods
A retrospective review of medical records was performed to identify patients with ALS that underwent PRG over a 14 year period. Demographic data, procedural details and post-procedure progress were tabulated. For the PVB group 24 hour pain score, analgesic use, sleep quality and overall analgesic satisfaction were prospectively collected.
Results
181 patients with ALS that underwent PRG were identified. The complication rate for the entire cohort was 30% (54/181), including severe pain (24/54) that required analgesic escalation or re-admission (none in the PVB group, p=0.36), perioperative tube dysfunction (13/54), stoma site infection (8/54), and minor bleeding (3/54). 30-day mortality was 7% (1 pneumonia possibly related to periprocedural aspiration). Of the 10 patients that received PVB the pain scores were mostly 0-2 (range 0-7), 4 experienced transient hypotension during the block, 8/10 reported good or very good sleep quality, all reported good, very good or excellent satisfaction with analgesia, and oral analgesic use was minimal (only 7 tablets of hydrocodone total between 10 patients within 24 hours).
Conclusions
PRG is safe in patients with ALS whether done with or without PVB. Analgesic escalation and re-admission were more likely in the non-PVB group but did not reach statistical significance, likely because the PVB group was small. With PVB oral analgesic use was minimal; sleep quality and overall analgesia were satisfactory in most PVB cases.