NERVE BLOCKS IN PALLIATIVE CARE
Fiona Hicks and Karen H. Simpson
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Oxford University Press, 2004
135 pp
ISBN 0-19-852703-9
RRP £19.95 $US39.50
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This book aims to provide a practical guide to nerve blocks and neuromodulation (techniques such as spinal drug delivery or spinal cord stimulation) so that palliative care professionals can
make informed decisions about which patients are appropriate to refer for specialized treatment.
Overall, there is a clear, concise description of the various procedures including indications, contraindications and adverse effects. However, I was a little surprised to see that coeliac
plexus blocks have to be performed under deep sedation or general anaesthesia, making it an unattractive option for frail or debilitated patients in palliative care; where I work, the blocks
are done by the interventional radiologists under CT-control, without general anaesthetic or sedation, with an appropriately good response rate and, so far, without mishap. I also thought that
intracerebroventricular injection of opioids deserved more discussion. It is mentioned only once in passing as an alternative for intractable pain in the head. Whilst the published series were
not prospectively controlled, there is now a body of evidence that this technique may be useful for intractable pain, including that outside the head and neck. And whilst I am carping, the repeated
use of “co-aggulopathy” is annoying and sounds painful.
This book meets its objective of providing the information needed for palliative care professionals to know what to expect of the various interventional techniques. But it would have been even
better if there were some discussion of the different options that are available for treating common pain syndromes in a given patient. For example, unilateral arm pain due to malignancy is listed
as a specific indication for a brachial plexus block. But what are the alternatives? Epidurals? Spinal opioids? My criticisms aside, this is a very useful text and definitely deserves a place
on the palliative care unit bookshelf.
Roger Woodruff
Director of Palliative Care, Austin Health, Melbourne, Australia
(November 2004)
Author Information
Dr. Fiona Hicks is Consultant in Palliative Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
Dr. Karen H. Simpson is Consultant in Palliative Pain Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
Table of Contents
1. Philosophy behind the use of interventional pain management techniques in palliative care
2. Defining the problem
3. Assessment of pain
4. Pain syndromes
5. Choice of technique
6. Simple peripheral nerve blocks and infections
7. Regional nerve blocks
8. Spinal drug delivery
9. Electrical stimulation techniques
10. Ethical issues
Index
