Surgical and Perioperative Palliative Care: Updates from 2019 (FR401)

Seriously ill patients with surgical problems face significant symptom burden, prognostic uncertainty, and complex decisions, and therefore warrant palliative care that is responsive to their surgical and perioperative needs. The core principles of surgery and anesthesiology closely mirror those of palliative care, and the intersection between them is increasingly reflected in the annual volume of emerging research. Examples include communication skills training for surgical providers, embedded inpatient and outpatient surgical palliative care programs, and preoperative advance care planning interventions.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research

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Prashant Sirohiya, Vinod Kumar, Pratishtha Yadav, Sachidanand Jee BhartiIndian Journal of Palliative Care 2020 26(1):140-141 Glossopharyngeal nerve (GPN) block is used for pain management in patients' head and neck malignancy. The GPN is a mixed nerve containing both motor and sensory fibers. The usual approaches for GPN blocks are usually topical, intraoral, or peristyloid. Topical anesthesia may be difficult in patients with limited mouth opening or when there is inflammation in the area of interest. Intraoral and peristyloid approaches have risk of inadvertent neurovascular injection. The intraoral technique may le...
Source: Indian Journal of Palliative Care - Category: Palliative Care Authors: Source Type: research
Children with end-stage illness may have DNR orders, which limit common operating room interventions such as intubation, administration of vasoactive medications, and CPR. However, many of these children may still benefit from surgeries, imaging, or other interventions requiring anesthesia, such as radiation therapy to palliate metastases, long-term central venous access for medications or parenteral nutrition, gastric tubes, or pleura or paracentesis to help with breathlessness or abdominal distension.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
CONCLUSION: Interventions commonly recommended by guidelines are not always supported by a robust evidence base. Research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies and transcutaneous electrical nerve stimulation. PMID: 31980005 [PubMed - as supplied by publisher]
Source: Palliative Medicine - Category: Palliative Care Authors: Tags: Palliat Med Source Type: research
AbstractPain is a common symptom associated with advanced cancer. An estimated 66.4% of people with advanced cancer experience pain from their disease or treatment. Pain management is an essential component of palliative care. Opioids and adjuvant therapies are the mainstay of cancer pain management. Nevertheless, a proportion of patients may experience complex pain that is not responsive to conventional analgesia. Interventional analgesia procedures may be appropriate and necessary to manage complex, cancer-related pain. This narrative review uses a theoretical case to highlight core principles of palliative care and inte...
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
AbstractConstipation, one of the adverse effects of opioid therapy with a major impact on quality of life, is still an unmet need for cancer patients, particularly those with an advanced and progressive disease, and for non-cancer patients chronically treated with opioids. The awareness of this condition is poor among healthcare providers, despite the recent publication of guidelines and consensus conferences. An early multidisciplinary approach of opioid-induced bowel dysfunction (OIBD), based on available therapies of proven effectiveness, could support clinicians in managing this condition, thus increasing patients &rsq...
Source: Supportive Care in Cancer - Category: Cancer & Oncology Source Type: research
Abstract Pain is a common symptom associated with advanced cancer. An estimated 66.4% of people with advanced cancer experience pain from their disease or treatment. Pain management is an essential component of palliative care. Opioids and adjuvant therapies are the mainstay of cancer pain management. Nevertheless, a proportion of patients may experience complex pain that is not responsive to conventional analgesia. Interventional analgesia procedures may be appropriate and necessary to manage complex, cancer-related pain. This narrative review uses a theoretical case to highlight core principles of palliative car...
Source: Canadian Journal of Anaesthesia - Category: Anesthesiology Authors: Tags: Can J Anaesth Source Type: research
Publication date: Available online 6 September 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Brigid BassamAbstractPain management in palliative care is both an art and a science. Essential to good pain control is an understanding not only of the pathophysiology of the origin of the pain, but also the impact that the pain is having, as the palliative patient may have to live with the symptoms of disease for months or even years. Interventions can then be targeted and at various times, may include a range of pharmacological treatments, psychological or spiritual support and possibly the involvement of other ...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Authors: Wu J, Ku SC, Ko AL Abstract A 51-year-old man with metastatic renal cell carcinoma whose fentanyl requirement was 3000-4000 µg/h in inpatient hospice presented for a thoracic (T) vertebral 4-10 posterior spinal fusion for a lytic T7 compression fracture. He underwent total intravenous (IV) anesthesia with propofol, remifentanil, and ketamine; liposome bupivacaine was locally infiltrated at the end of the case. Following extubation on postoperative day (POD) 1, he had severe pain refractory to high-dose IV fentanyl patient control analgesia and ketamine infusion. His pain dramatically improved ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
Access to internationally controlled essential medicines is a problem worldwide. More than 5 billion people cannot access opioids for pain and palliative care or do not have access to surgical care or anesthetics, 36 million people living with epilepsy do not have access to their medicines, and 120.000 women die annually due to post-partum hemorrhage. In Uganda access to controlled medicines is also problematic, but a lack of data on factors that influence access exists.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research
Publication date: Available online 2 July 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Christopher JG. Green, Somnath BagchiAbstractOpiates remain the mainstay of the management of severe pain in acute, chronic and palliative settings across all population ages. Pharmacological advancement allows alternative routes of drug delivery best suited to individual patients and their conditions, with improved efficacy and safety. The different approaches to administration vary in their convenience, both to staff and patients, which can translate to differences in prescription compliance. Furthermore, the choice o...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
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