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Lumbar paravertebral blockade as intractable pain management method in palliative care

Overview of attention for article published in OncoTargets and therapy, September 2013
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Title
Lumbar paravertebral blockade as intractable pain management method in palliative care
Published in
OncoTargets and therapy, September 2013
DOI 10.2147/ott.s43057
Pubmed ID
Authors

Aleksandra Kotlinska-Lemieszek, Grzegorz Kowalski, Katarzyna Kosicka, Karolina Hoffmann, Franciszek Glówka, Jacek Luczak, Iwona Zaporowska-Stachowiak

Abstract

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour(-1)) or in boluses (10 mL of 0.125%-0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine's side effects were absent. Coadministered drugs could mask LA's toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine's elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9-927.4 ng mL(-1)). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours(-1)) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours(-1)) had an acceptable risk-benefits ratio, but was ineffective.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 31 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 31 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 10 32%
Student > Ph. D. Student 5 16%
Other 4 13%
Unspecified 3 10%
Researcher 3 10%
Other 6 19%
Readers by discipline Count As %
Medicine and Dentistry 15 48%
Unspecified 4 13%
Nursing and Health Professions 3 10%
Immunology and Microbiology 1 3%
Agricultural and Biological Sciences 1 3%
Other 7 23%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 December 2013.
All research outputs
#5,294,071
of 6,229,233 outputs
Outputs from OncoTargets and therapy
#450
of 762 outputs
Outputs of similar age
#116,450
of 143,417 outputs
Outputs of similar age from OncoTargets and therapy
#18
of 33 outputs
Altmetric has tracked 6,229,233 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
So far Altmetric has tracked 762 research outputs from this source. They receive a mean Attention Score of 1.2. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 143,417 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 33 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.