BACKGROUND AND OBJECTIVES: Neurolytic superior hypogastric plexus block has been shown to be safe and effective in selected cancer patients. A large cohort of patients was studied to evaluate the continued efficacy and safety of this block in cancer patients with advanced disease. METHODS: A total of 227 pelvic pain patients with gynecological, colorectal, or genitourinary cancer who experienced poor pain control due to either progression of disease or to untoward side effects were enrolled in this study during a 3-year period. All pain patients receiving oral opioids were eligible to participate. A bilateral percutaneous neurolytic superior hypogastric plexus block with 10% phenol was performed 1 day after a successful diagnostic block with 0.25% bupivacaine. RESULTS: All patients reported a visual analog scale (VAS) pain score of 7-10/10 before the block. A positive response to a diagnostic block was obtained in 159 patients (79%). Overall, 115 patients of the 159 patients who responded to a diagnostic block (72%, 95% confidence interval of 65-79%) had satisfactory pain relief (VAS < 4/10), 99 (62%) after one block, and 16 (10%) after a second block. The remaining 44 patients (28%) had moderate pain control (VAS 4-7/10) after two blocks and received oral pharmacological therapy and epidural analgesic therapy with good results. Both groups experienced significant reductions in oral opioid therapy after the neurolytic blocks. No additional blocks were required by patients who had a good response during a follow-up period of 3 months. No complications related to the block were detected. CONCLUSIONS: Neurolytic superior hypogastric plexus block provided both effective pain relief and a significant reduction in opioid usage (43%) in 72% of the patients who received a neurolytic block. Overall, this represents 51% of the patients enrolled in the study. Poor results should be expected in patients with extensive retroperitoneal disease overlying the plexus because of inadequate spread of the neurolytic agent.
BACKGROUND AND OBJECTIVES: Neurolytic superior hypogastric plexus block has been shown to be safe and effective in selected cancerpatients. A large cohort of patients was studied to evaluate the continued efficacy and safety of this block in cancerpatients with advanced disease. METHODS: A total of 227 pelvic painpatients with gynecological, colorectal, or genitourinary cancer who experienced poor pain control due to either progression of disease or to untoward side effects were enrolled in this study during a 3-year period. All painpatients receiving oral opioids were eligible to participate. A bilateral percutaneous neurolytic superior hypogastric plexus block with 10% phenol was performed 1 day after a successful diagnostic block with 0.25% bupivacaine. RESULTS: All patients reported a visual analog scale (VAS) pain score of 7-10/10 before the block. A positive response to a diagnostic block was obtained in 159 patients (79%). Overall, 115 patients of the 159 patients who responded to a diagnostic block (72%, 95% confidence interval of 65-79%) had satisfactory pain relief (VAS < 4/10), 99 (62%) after one block, and 16 (10%) after a second block. The remaining 44 patients (28%) had moderate pain control (VAS 4-7/10) after two blocks and received oral pharmacological therapy and epidural analgesic therapy with good results. Both groups experienced significant reductions in oral opioid therapy after the neurolytic blocks. No additional blocks were required by patients who had a good response during a follow-up period of 3 months. No complications related to the block were detected. CONCLUSIONS: Neurolytic superior hypogastric plexus block provided both effective pain relief and a significant reduction in opioid usage (43%) in 72% of the patients who received a neurolytic block. Overall, this represents 51% of the patients enrolled in the study. Poor results should be expected in patients with extensive retroperitoneal disease overlying the plexus because of inadequate spread of the neurolytic agent.
Authors: Pia Bader; Dieter Echtle; Valerie Fonteyne; Kostas Livadas; Gert De Meerleer; Alvaro Paez Borda; Eleni G Papaioannou; Jan H Vranken Journal: World J Urol Date: 2012-02-09 Impact factor: 4.226
Authors: David Hao; Shawn Sidharthan; Juan Cotte; Mary Decker; Mariam Salisu-Orhurhu; Dare Olatoye; Jay Karri; Jonathan M Hagedorn; Peju Adekoya; Charles Odonkor; Amitabh Gulati; Vwaire Orhurhu Journal: Curr Pain Headache Rep Date: 2021-05-07
Authors: Ivan Urits; Ruben Schwartz; Jared Herman; Amnon A Berger; David Lee; Christopher Lee; Alec M Zamarripa; Annabel Slovek; Kelly Habib; Laxmaiah Manchikanti; Alan D Kaye; Omar Viswanath Journal: Curr Pain Headache Rep Date: 2021-02-25
Authors: Ekramy M Abdelghafar; Ahmed H Othman; Mahmoud Salem Soliman; Ayman Kilany; Mohammed H Shaaban; Ehab H Shaker Journal: J Pain Res Date: 2021-05-27 Impact factor: 3.133