Background: Intranasal sphenopalatine ganglion (SPG) block has been shown to be an effective treatment for headaches. Multiple therapeutic agents have been studied, although the wide availability and low cost of lidocaine and bupivacaine have made them attractive treatment options. To the authors knowledge, no study has yet demonstrated superiority of one anesthetic over the other. Objective: To determine the efficacy of lidocaine versus bupivacaine when performing intranasal sphenopalatine ganglion (SPG) block for the treatment of headaches. Study Design: Retrospective cohort study. Setting: A single tertiary care academic institution Methods: This retrospective study identified patients who underwent SPG block at a single institution from January 1, 2014 to December 20, 2017. Patients were included if they were treated with either lidocaine or bupivacaine and had both pre- and post-procedure pain scores recorded on a 0-10 scale. Patients were excluded if they were less than 18 years of age. Results: 386 total procedures were performed. 303 (78.5%) were lidocaine delivered via the SphenoCath device, and 83 (21.5%) were bupivacaine delivered via the Tx360 device. 90.2% of treatments (n = 348) decreased the patient’s pain level. Of the treatments performed with lidocaine, 89.1% (n = 270) resulted in improvement of the patient’s pain level with a mean decrease in pain level of 3.1 (SD ± 2.3). Of the treatments performed with bupivacaine, 94.0% (n = 78) resulted in improvement of the patient’s pain level, with a mean decrease in pain level of 3.0 (SD ± 1.9). No statistically significant difference was found between the 2 anesthetics. Limitations: The retrospective study design may introduce selection bias. Both lidocaine and bupivacaine were administered by different devices (Sphenocath and Tx360 respectively) which may account for differences in initial treatment success. There were differences in the size of the two groups, which may also introduce error. Conclusions: This study demonstrates similar efficacy of SPG block performed with lidocaine or bupivacaine. While no difference was found, the particular advantages and disadvantages of the intranasal delivery device may influence physician choice. Key words: Sphenopalatine ganglion nerve block, lidocaine, bupivacaine, sphenocath, Tx360, pain intervetnio, headache, miimally invasive therapy
The presence of liver metastasis in pancreatic cancer patients portends a very poor prognosis; the reported median overall survival (OS) is 2.8 months without treatment 1 and 5.7 months with systemic therapy. 2 The purpose of this study is to evaluate the safety and efficacy of transarterial hepatic radioembolization in pancreatic cancer patients with liver-dominant metastatic disease. Materials: From April 2010 to September 2017, 26 patients (10 male, 14 female, average age of 65.5, range: 44 -83) with metastatic pancreatic adenocarcinoma to the liver were treated with yttrium-90 (Y90) glass microsphere radioembolization. 19 had extrahepatic disease at the time of radioembolization. Prior to radioembolization 8 patients had a pancreatectomy. All patients received systemic chemotherapy prior to Y90 embolization and 19 received systemic therapy after embolization. 2 patients had other liver-directed therapy prior to embolization and none had liverdirected therapy after. Retrospective review of medical records and imaging studies was performed to evaluate toxicities, treatment response, and overall survival. The median follow-up period from Y90 embolization was 13 months (range, 1 -85 months). Results: Median OS from Pancreatic adenocarcinoma diagnosis was 30.7 months (95% CI, 20.3-41.1 months), from diagnosis of liver metastasis was 21.8 months (95% CI, 17.2 -26.3 months), and from radioembolization treatment was 7.0 months (95% CI, 2.0 -12.0 months). After treatment, 21 patients reported grade 1 and 2 clinical toxicities, and 24 patients had grade 1 and 2 biochemical toxicities. 7 patients experienced grade 3 toxicities, with 4 patients having grade 3 clinical toxicities and 6 patients having grade 3 biochemical toxicities. Imaging at 3 months after treatment demonstrates partial response in 1 patient, stable disease in 9 patients, and progression of disease in 12 patients by RECIST criteria. 4 patients had no follow-up imaging. Conclusions: Radioembolization is safe and led to promising overall survival in pancreatic cancer patients with liver-dominant metastatic disease.
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