Procedures of Locoregional Analgesia and Quality of Life in Palliative Care Units

Study Overview
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Brief Summary
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Number of patients in mobile palliative care units have pain of both nociceptive and neuropathic origin. In certain cases, procedures of locoregional analgesia can be helpful. The Purpose of this study is to evaluate the impact of techniques of locoregional analgesia in a palliative population

Detailed Description
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Cancer pain is a serious problem in the palliative population. In particular, pain due to compression or invasion of nerve tissue by metastasis is frequent and often unresponsive to oral drug therapy and even to epidural administration of opioids. In such refractory pain in a palliative setting, one modality that could be helpful is the use of technics of locoregional analgesia. Currently, they are routinely used for the management of acute postoperative pain and become to be more widely used for cancer surgery. For example, intrapleural intercostal nerve blocks after major lung resection or preincisional paravertebral blocks after breast surgery have been shown to improve pain control. However, locoregional analgesia is only occasionally used in chronic cancer pain. The procedures used are epidural analgesia, rachianesthesia, or continuous nerve blocks. L-bupivacaine will be used. The procedure will be performed only if the injection test is positive. The patients will be evaluated before and after the procedure, the patient being his/her own control. Evaluations will take place immediately before the procedure, then at 48 hours, 1 week and 1 month after the procedure.

Official Title
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Procedures of Locoregional Analgesia and Quality of Life in Palliative Care

Conditions
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Pain

Intervention / Treatment
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* Drug: opioids


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient ≥ 18 years-old, male or female, whatever his/her ethnic group Patient with untreatable cancer Patient hospitalized in a palliative care unit, with a life expectancy ≥ 1 week Pain unresponsive to conventional treatments Effectiveness of the injection test Signed informed consent Exclusion Criteria: Patients > 18 years-old Patients with pain other than cancer pain Patient's refusal Coagulation disorders Local infection Known hypersensitivity to local analgesics Inefficacy of the injection test. Contraindication for analgesics

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: opioids|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in patients global quality of life | To evaluate the change in patients global quality of life, assessed by the item 15 of the validated quality of life scale EORTC QLQ-C15 PAL. Evaluations will take place before the procedure of locoregional analgesia and 1 week after. | 1 week after first injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in patient's global quality of life | evaluate the change in EORTC QLQ-C15 PAL score, assessed before the procedure of locoregional analgesia and 1 week after. evaluate the change in patient's global quality of life, assessed by the item 15 of the validated quality of life scale EORTC QLQ-C15 PAL at 48 hours and 1 week post-procedure. evaluate pain at 48 hours post-procedure evaluate the change in doses of conventional treatments at 1 week | 2 days and 1 week after procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cancer pain