Abstracts The Journal of Pain S67

(364) Usefulness of epidural catheter with the subcutaneousreservoir for cancer pain in homecare service

D Inoue, T Sakuyama, Y Katoh, Y Mio, Y Tanifuji, T Kinoshita,and T Matsumoto; The Jikei University School of Medicine, Minato, Tokyo, Japan

In recent years, the number of cancer patients and their families desiring palli-ative home-based care has been increasing in Japan. The epidural block ther-apy is offered to reduce the side effects of systemic administration of opioidssuch as drowsiness. It is necessary to set a subcutaneous reservoir to preventthe catheter-related infection for home-based care in a long period. 125 pa-tients with this manipulation during 2004 to 2010 showed significant improve-ment in their pain level calculating by Numerical Rating Scale (NRS). A catheterrelated infection was occurred in two cases (methicillin resistant staphylococ-cus aureus; MRSA and Staphylococcus capitis). However only 30 cases couldbe proceed to home-based care in these cases. The reasons for the delay to pro-ceed to home-based care for cancer patients in Japan are as followed: 1) Vari-ous changes in symptoms and poor pain control 2) Social factors such aspatients’ family being in mid-career and the presence of young children athome 3) A lack of communication among medical team members includinggeneral practitioners, nurses, social workers and chemotherapists. It is criticalfor hospital doctors to share the thoughts among medical team membersand we should establish the common guidelines for the management of theepidural catheter with subcutaneous reservoir to make an optimal timingproceeding to home-based care.

(365) Which approach should you choose: sciatic nerve block orepidural block? A review and analysis of benefits compar-ison: continuous sciatic nerve block and continuous epi-dural block after reconstructive surgery of ankle and foot

T Terada, T Mae, N Haruyama, T Arashi, A Abe, T Yamasaki, and M Ozaki;Tokyo Metropolitan Police Hospital, Nakano, Tokyo, Japan

Continuous epidural block is commonly performed to provide anesthesia or an-algesia for patients undergoing reconstructive surgery of ankle and foot. Thistherapeutic method, however, does not have adaptation for patients using an-ticoagulant, patient’s backbone transformed tremendously or vital sign is un-stable. We proactively provided continuous sciatic nerve block to thesepatients during and after reconstructive surgery of ankle and foot. Forty pa-tients were randomly divided into two groups to receive gluteal approachfor continuous sciatic nerve block (n=20) and continuous epidural block(n=20). From the beginning of surgery, for both groups, patients were assignedto received 0.2% Ropivacaine 4ml/h with a possible addition of 3ml every 30min via a patient-controlled bolus dose at least 24 hour. Pain control was mea-sured by Numeric Rating Score (NRS). Post operative Nausea and vomiting(PONV), numbness, and use of analgesics were monitored for 48 hours aftersurgery. There were no significant statistical differences in NRS pain scores be-tween epidural block and sciatic nerve block approaches, at the point of 0h, 6hand 24h post operation(p<0.05). And these two studies show no statistical dif-ference in the incidence of nausea and vomiting. Also our studies show therewas no statistical difference by the two approaches in the use of analgesicsas well. The Mann-Whitney U test was used to analyze difference betweentwo groups and the chai-square test was used for the other categorizeddata. A statistically significant difference was considered when p value wasless than 0.05(p<0.05). Continuous sciatic nerve block provides postoperativeanalgesia which is comparable with those test results obtained from epiduraltechnique, suggesting the best balance between analgesia and side effectssuch as PONV and numbness.

(366) The effectiveness of Lumbar sympathetic nerve block forneurogenic intermittent claudication in lumbar spinalstenosis

M Ifuku; Juntendo University, Tokyo, Japan

Lumbar spinal stenosis (LCS) is classified as radiculopathy (Sciatica) type, caudaequine type (Intermittent claudication :IMC). Radiculopathy type is spontane-ous remission of disease, but cauda equine type is not effect of conservativetherapy. Because of IMC is precipitated by neural ischemia in cauda equine.The past report from says Lumbar sympathetic nerve block (LSNB) increasesblood flow in a dog model of chronic cauda equine compression. So we exam-ined the effectiveness of LSNB for IMC in LCS. We collected patient with caudaequine type LCS, and blocked bilateral LSN with neurolytic agent. After 1&2&6months, we evaluated effectiveness by the Swiss Spinal Stenosis Questionnaire(SSS). In 25 PHN patients being treated LSNB and completed follow up. The SSSimprovement significantly compared with that before and after block in allpoint (p < 0.05). And the complication of this block was miner and transitory.Lumbar sympathetic nerve block is one of the useful therapy for neurogenicintermittent claudication in lumbar spinal stenosis.

(367) Radiofrequency of the sural nerve: three case reports fortreating chronic neuropathic painwith radiofrequency ofthe sural nerve in the veteran and civilian population

S Cheema and F Soumekh; VA Boston Healthcare System, Boston, MA

Radiofrequency has been a controversial interventional approach for chronicperipheral neuropathic pain. We report three cases in which this techniquewas employed, resulting in more successful pain relief than with other treat-ments (including pharmacotherapy, physical therapy, and other interventions).The first case is a 28 year-old male Veteran with a history of PTSD and chronicbilateral ankle pain, s/pmultiple surgeries, with EMGevidence of severe axonalneuropathy of the left sural nerve. He hadmultiple IV lidocaine infusions, pop-liteal nerve blocks, neuroma injections and sural nerve blocks (with steroid andusing nerve stimulator); these treatments would provide 30% relief for at least3weeks. Pulsed radiofrequency of the sural nerve provided relief of dysestheticsymptoms for at least 8 weeks. The second case is a 57 year-old male Veteranwith a history of right stump pain above the ankle after a crush injury. Hehad limited relief with three sural nerve injections with steroid using nervestimulator. Radiofrequency treatment provided 40-60% relief for one month,and increased functional use of prosthesis. The third case is a 63 year-old civilianwith a history of central thalamic pain syndrome and right leg pain for twentyyears. Previous interventions, including thalamectomy, chemodenervation, bo-tox, neuroma injections and sural nerve blocks with steroid, provided little tono relief. Radiofrequency provided 100% pain relief and decrease in spasticityfor more than six months. In conclusion, these cases present a use for radiofre-quency as another potential treatment modality for helping patients withchronic neuropathic pain.