Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Int Med Res. 2024 Aug;52(8):3000605241270677. doi: 10.1177/03000605241270677.
Cancer survivors often face persistent abdominal pain, necessitating optimal pain management. While celiac plexus block (CPB) and botulinum toxin (BT) injection are viable options, traditional methods may encounter challenges due to patient-specific concerns and anatomical complexities. Here, the case of a cancer survivor in his 70 s experiencing recurrent abdominal pain, who declined conventional percutaneous CPB approaches due to anxiety related to aortic puncture, is presented. Following a pancreaticoduodenectomy, the patient developed chronic abdominal pain attributed to adhesions leading to small bowel obstruction. Concurrently, there was notable psychological distress, including anxiety, depression, and heightened concerns regarding tumor recurrence. Considering the patient's specific concerns, a right-sided unilateral retrocrural single-needle technique was proposed, aimed at alleviating pain, while avoiding conventional CPB approaches. Initial right-sided retrocrural CPB offered short-term relief, prompting a subsequent BT injection using the same approach. Following BT injection, the patient reported significant and sustained pain reduction (from 8 to 1 on an 11-point numerical rating scale) at both 12 and 20 weeks post-procedure. Right-sided retrocrural BT injection offers an alternative approach, addressing patient concerns and demonstrating prolonged pain relief. This may benefit cancer survivors with upper abdominal pain, emphasizing the importance of personalized and innovative pain management strategies.
癌症幸存者常面临持续性腹痛，需要进行优化的疼痛管理。腹腔神经丛阻滞（CPB）和肉毒毒素（BT）注射是可行的选择，但由于患者的具体问题和解剖结构的复杂性，传统方法可能会遇到挑战。这里报告了一位 70 多岁的癌症幸存者的病例，他因主动脉穿刺相关焦虑而拒绝传统的经皮 CPB 方法，反复出现腹痛。在胰十二指肠切除术后，患者出现慢性腹痛，归因于粘连导致小肠梗阻。同时，他还存在明显的心理困扰，包括焦虑、抑郁和对肿瘤复发的高度担忧。考虑到患者的具体问题，提出了一种右侧单侧经后路单针技术，旨在缓解疼痛，同时避免传统的 CPB 方法。初次右侧经后路 CPB 提供了短期缓解，随后使用相同的方法进行 BT 注射。BT 注射后，患者报告在术后 12 周和 20 周时疼痛显著且持续减轻（从 11 分数字评分量表的 8 分降至 1 分）。右侧经后路 BT 注射提供了一种替代方法，解决了患者的担忧，并显示出持久的疼痛缓解。这可能对有上腹痛的癌症幸存者有益，强调了个性化和创新的疼痛管理策略的重要性。
