Research Article

Preliminary Survey of Chronic Pain Treatments by Epidural Block Via Home Visit

by Koki Shimoji1-3*, Keiko Yamakawa1, Haruka Goto1, Chou Chewei1

1Integrated Preventive Medical Clinic. 2-6-27 Kasumi, Narashino, Chiba 275-0022, Japan

2Pain Control Institute,45-304 Yarai-cho, Shinjuku-ku, Tokyo 162-0805, Japan

3Department of Anesthesiology, Niigata University Graduate School of Medicine, Asahi-machi 1, Chuo-ku, Niigata, Japan

*Corresponding author: Koki Shimoji, Pain Control Institute,45-304 Yarai-cho, Shinjuku-ku, 162-0805 Tokyo, Japan

Received Date: 18 January, 2024

Accepted Date: 22 January, 2024

Published Date: 24 January, 2024

Citation: Shimoji K, Yamakawa K, Goto H, Chewei C (2024) Preliminary Survey of Chronic Pain Treatments by Epidural Block Via Home Visit. J Surg 9: 1985


Background: Pain management for patients at home, who hardly walk to visit a hospital or were homebound, may be a major challenge for pain control.

Objective: To provide the epidural block (EpB) techniques by home visit for small groups of patients suffering from chronic pain who were homebound or could not walk to visit the outpatient clinic,

Study Design: Evaluation of the EpBs by home visit in these chronic pain patients.

Setting: In response to the general practitioners, we organized the epidural block teams for home visit treatments.

Methods: Our team conducted the EpBs via home visit for these chronic pain patients.

Results: A numerical rating scale (NRS) was decreased by this home visit treatment in all patients, and activity in daily life (ADL) were increased in 16 of 25 patients at one week and/or at the time of termination of our visit.

Conclusions: The EpBs might be valuable for these patients with chronic pain who were homebound or hardly walk to visit a hospital and should be conducted by the pain control team trained in nerve block techniques as well as resuscitation skills and close communication tools to be provided for the patients and their families.

Keywords: Chronic pain; Epidural block; Home visit; Pain management


Chronic pain is a significant health problem particularly for the elderly and may lead to frailty [1-3]. There are a large number of patients who hardly walk to visit the outpatient clinics and/or are forced to stay at home with their families. Although approximately 70% of people in this country hope to stay in their homes for chronic pain care, roughly the same percent of people receive end-of-life care at hospitals or similar facilities due to medical insurance services and the rapid progression of the ‘nuclear family’ [4]. Actual numbers note that about 65% of people die at home and 35% die at a hospital in this country [4]. A report has noted, however, that more accessible home and hospice services are required through arranging regional resources to reduce family burden, alleviating patient-perceived burdens, and improving 24-h support at home [5]. We believe that pain clinicians and their teams should be more assigned to treat not only chronic pain of active workers but also these kinds of patients at home, as the population pyramid shows a rapid increase in the elderly worldwide [2,5]. Despite these social circumstances, there have been scarce reports except the caudal epidural blocks reported [6] on pain treatments in patients with chronic pain at home, who hardly walk to visit outpatient pain clinics. The present report surveys the preliminary results of our experiences using the epidural block treatments in these patients. The initial experience was reported elsewhere [7].

Methods and Procedures

The proposed treatment, with possible side effects, was explained to all patients and their families and the consent obtained before each visit. The epidural blocks (EpBs) were performed in 24 of 25 patients in response to -requests by local practitioners (GPs, home doctors). Before the patients were treated, a conference was held to prepare for home visits with each practitioner (9 orthopedists, 11 internists). During our first home visit, the procedures were explained at the patients’ bedside, attended by their families, the practitioners, home nurses, and hospital office personnels. Each patient was duly informed of the disease by the home doctor and had achieved a good understanding. There were no patients with coagulopathy. All patients that were taking the Nonsteroidal-Anti-Inflammatory Drugs (NSAIDs) and pregabalinrelated drugs before, during and after our visits were instructed to continue to do so. On the day of our visits, we carried bags which included the portable epidural block sets (Figure 1), the portable sphygmomanometer, a pulse oximeter, the drip set with a 200ml saline pack, and drugs such as adrenaline (1.0 mg), noradrenaline (1.0 mg), atropine (0.5 mg), diazepam (10 mg), morphine (10mg), about 1~2 ampules of each. An Ambu bag was also prepared for emergencies during each visit. Before leaving the patient’s home, we ensured that the patient was comfortable and free from any ill effects of the treatment. At the same time, we requested the patient’s home doctors, general practitioners, for their evaluation of our treatments.