Gawel Richard J, Kramer Jeffrey A, Shalaby Michael
Hospital of the University of Pennsylvania, Department of Emergency Medicine, Philadelphia, Pennsylvania.
Clin Pract Cases Emerg Med. 2025 May;9(2):129-133. doi: 10.5811/cpcem.39723.
Breakthrough pain is frequently experienced by patients with gastrointestinal malignancies and is a common reason for presenting to the emergency department (ED). After ruling out acute pathology, ED management typically consists of intravenous opioids, although high doses of opioids can be associated with potentially severe adverse events and complications in certain high-risk populations. Regional anesthesia strategies, such as the erector spinae plane block (ESPB), have been shown to be effective for several etiologies of non-malignant visceral abdominal pain. In this case series we sought to evaluate whether the ESPB can be effective for ED patients with breakthrough pancreatic and hepatobiliary cancer pain.
Three patients with breakthrough hepatopancreatobiliary cancer pain underwent successful ESPBs performed by an emergency physician in the ED. All patients reported considerable reduction in their pain. Two patients with cancer of the pancreatic head reported complete pain relief and were able to be discharged from the ED. The third patient with metastatic colorectal cancer involving the hepatobiliary system was admitted for further medical workup, although he did not require any additional analgesics for nearly 13 hours after the block.
The erector spinae plane block appears to be a safe and effective strategy for managing breakthrough pain related to pancreatic and hepatobiliary malignancy in the ED.
胃肠道恶性肿瘤患者经常经历爆发性疼痛，这是他们前往急诊科（ED）就诊的常见原因。在排除急性病变后，急诊科的管理通常包括静脉注射阿片类药物，尽管高剂量阿片类药物在某些高危人群中可能会引发潜在的严重不良事件和并发症。区域麻醉策略，如竖脊肌平面阻滞（ESPB），已被证明对多种非恶性内脏腹痛病因有效。在本病例系列中，我们试图评估ESPB对急诊科患有爆发性胰腺癌和肝胆癌疼痛的患者是否有效。
三名患有爆发性肝胆胰腺癌疼痛的患者在急诊科由一名急诊医生成功实施了ESPB。所有患者均报告疼痛显著减轻。两名胰头癌患者报告疼痛完全缓解，并能够从急诊科出院。第三名患有累及肝胆系统的转移性结直肠癌患者入院接受进一步检查，尽管在阻滞术后近13小时内他不需要任何额外的镇痛药。
竖脊肌平面阻滞似乎是急诊科管理与胰腺和肝胆恶性肿瘤相关的爆发性疼痛的一种安全有效的策略。
