S A Amr1, R M Reyad2, A H Othman1, M F Mohamad1, M M Mostafa1, N H Alieldin3, F A Hamed1. 1. Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt. 2. Department of Anesthesia, and Pain Relief, National Cancer Institute, Cairo University, Egypt. 3. Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Egypt.
Abstract
BACKGROUND:Radiofrequency ablation (RFA) of the splanchnic nerves has been reported as a predictable and safe technique for abdominal pain management. We compare between RFA and chemical neurolysis of bilateral thoracic splanchnic nerves in the management of refractory cancer pain. METHODS: The study was conducted on 60 patients aged ≥18 years who suffered from abdominal pain (visceral pain, VAS ≥4) due to upper abdominal cancers. Participants were randomized into two groups. Group I (RF): 30 participants received a bilateral splanchnic nerve block at T10 and T11 levels using RFA. Group II (alcohol): 30 participants received a bilateral splanchnic nerve block at T11 using alcohol. Pain relief was assessed using VAS (0-10) and total daily oral opioid consumption (primary outcome). RESULTS: Significant reductions of VAS and global perceived effect satisfaction scores (GPES) were observed in both groups compared to baseline levels (p < 0.001); Group I had the largest reduction. MST consumption and QOL scores improved significantly in both groups (p < 0.001). Oral opioid consumption started to reduce at the end of the first post-interventional week for Group I, 0.00 (0-45 mg), and at the end of the second post-interventional week for Group II, 20.00 (0-135 mg). No major complications were recorded in either group. CONCLUSION: Simultaneous bilateral pain block of splanchnic nerves at the levels of T10 and T11 using RFA is more effective than using alcohol at a single level of T11 in cancer patients presenting with upper abdominal pain. The RFA intervention acted faster, provided longer duration analgesia, worked in a higher proportion of patients and had a better safety profile than the alcohol intervention. SIGNIFICANCE: Radiofrequency ablation of the splanchnic nerves is safe and effective for relieving upper abdominal cancer pain.
RCT Entities:
BACKGROUND: Radiofrequency ablation (RFA) of the splanchnic nerves has been reported as a predictable and safe technique for abdominal pain management. We compare between RFA and chemical neurolysis of bilateral thoracic splanchnic nerves in the management of refractory cancer pain. METHODS: The study was conducted on 60 patients aged ≥18 years who suffered from abdominal pain (visceral pain, VAS ≥4) due to upper abdominal cancers. Participants were randomized into two groups. Group I (RF): 30 participants received a bilateral splanchnic nerve block at T10 and T11 levels using RFA. Group II (alcohol): 30 participants received a bilateral splanchnic nerve block at T11 using alcohol. Pain relief was assessed using VAS (0-10) and total daily oral opioid consumption (primary outcome). RESULTS: Significant reductions of VAS and global perceived effect satisfaction scores (GPES) were observed in both groups compared to baseline levels (p < 0.001); Group I had the largest reduction. MST consumption and QOL scores improved significantly in both groups (p < 0.001). Oral opioid consumption started to reduce at the end of the first post-interventional week for Group I, 0.00 (0-45 mg), and at the end of the second post-interventional week for Group II, 20.00 (0-135 mg). No major complications were recorded in either group. CONCLUSION: Simultaneous bilateral pain block of splanchnic nerves at the levels of T10 and T11 using RFA is more effective than using alcohol at a single level of T11 in cancerpatients presenting with upper abdominal pain. The RFA intervention acted faster, provided longer duration analgesia, worked in a higher proportion of patients and had a better safety profile than the alcohol intervention. SIGNIFICANCE: Radiofrequency ablation of the splanchnic nerves is safe and effective for relieving upper abdominal cancer pain.
Authors: Dimitrios K Filippiadis; Steven Yevich; Frederic Deschamps; Jack W Jennings; Sean Tutton; Alexis Kelekis Journal: Curr Oncol Rep Date: 2019-11-25 Impact factor: 5.075
Authors: Mansoor M Aman; Ammar Mahmoud; Timothy Deer; Dawood Sayed; Jonathan M Hagedorn; Shane E Brogan; Vinita Singh; Amitabh Gulati; Natalie Strand; Jacqueline Weisbein; Johnathan H Goree; Fangfang Xing; Ali Valimahomed; Daniel J Pak; Antonios El Helou; Priyanka Ghosh; Krishna Shah; Vishal Patel; Alexander Escobar; Keith Schmidt; Jay Shah; Vishal Varshney; William Rosenberg; Sanjeet Narang Journal: J Pain Res Date: 2021-07-16 Impact factor: 3.133