scholarly journals Effectiveness of Superior Hypogastric Plexus Neurolysis for Pelvic Cancer Pain

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. 203-208
Author(s):  
Berenice Carolina Hernández-Porras
Keyword(s):  
Cancer Pain ◽  
Pelvic Pain ◽  
Pain Treatment ◽  
Opioid Consumption ◽  
Hypogastric Plexus ◽  
Pelvic Cancer ◽  
Significant Difference ◽  
International Report ◽  
Superior Hypogastric Plexus ◽  
Influential Variable

Background: The superior hypogastric plexus block has been indicated for visceral pelvic pain treatment associated with malignancy. The first international report of this technique was published by Plancarte et al, in which a posterior percutaneous approach guided by fluoroscopy was described by applying neurolytic agents. The considerable variability in the data reported gave rise to 2 clinical approaches to those who performed the blockade early and those who executed it at a later stage of cancer. Objectives: The present study aims to provide more evidence regarding the effectiveness of this procedure. Study Design: This is a retrospective, longitudinal, descriptive study. Setting: The study was held at the pain unit service of the National Cancer Institute, Mexico City. Methods: A nonprobabilistic sample was selected; the data collection took place from January 2006 to December 2016 with patients diagnosed with pelvic pain, confirmed by imaging and biopsy studies. Patients who received any other type of intervention of the sympathetic axis, patients with a different approach than the classic or paravertebral technique, and patients with low survival rate were excluded. The Student t test was used to measure the significant difference between Visual Analog Scale (VAS) and morphine equivalent daily dose. The Cochran–Mantel– Haenszel test and the Gamma test were used to measure the association between the initial Karnofsky and blockade success. Results: The study included a total of 180 patients. The success rate was 59.4% at 1 month, 55.5% at 3 months, and 48.8% at 6 months. There was a sustained and significant VAS reduction that was 49.55% at 3 months. A significant reduction in opioid consumption of 12.55% was found at 3 months. There was no significant statistical evidence related to either opioid consumption or the functionality of the patient before the blockade as an influential variable in the success of the procedure. Limitations: Retrospective study, developed in a single center. Conclusions: Although opioids remain the cornerstone of cancer pain treatment, they produce many deleterious side effects. The superior hypogastric plexus neurolysis represents a reproducible and effective alternative in the management of pain in this group of patients. Key words: Pelvic pain, neoplasms, chemical neurolysis, pain management, cancer pain, palliative care, analgesia, nerve block

scholarly journals Pulsed Radiofrequency of the Sacral Roots Improves the Success Rate of Superior Hypogastric Plexus Neurolysis in Controlling Pelvic and Perineal Cancer Pain. Randomized Trial

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. 149-157
Author(s):  
Diab Fuad Hetta
Keyword(s):  
Cancer Pain ◽  
Pain Score ◽  
Pelvic Pain ◽  
Mean Difference ◽  
Perineal Pain ◽  
Pulsed Radiofrequency ◽  
Post Procedure ◽  
Hypogastric Plexus ◽  
Pelvic Cancer ◽  
Superior Hypogastric Plexus

Background: Superior hypogastric plexus neurolytic (SHP-N) block is the mainstay management for pelvic cancer pain of visceral origin when oral opioids fail due to inefficacy or intolerance to side effects. Unfortunately, SHP-N has the potential to control pelvic pain in 62%-72% of patients at best, because chronic pelvic pain may assume additional characteristics other than visceral. Objective: Combining SHP-N with pulsed radiofrequency (PRF) of the sacral roots might block most of the pain characteristics emanating from the pelvic structures and improve the success rate of SHP-N in controlling pelvic and perineal cancer pain. Study Design: This study was a prospective randomized controlled clinical trial. Settings: The research took place in the interventional pain unit of a tertiary center in the university hospital. Methods: Fifty-eight patients complaining of cancer-related chronic pelvic and perineal pain were randomized to either the PRF + SHP group (n = 29), which received SHP-N combined with PRF of the sacral roots S2-4, or the SHP group (n = 29), which received SHP-N alone. The outcome variables were the percentage of patients who showed a > 50% reduction in their Visual Analog Scale (VAS) pain score, the VAS pain score, and global perceived effect evaluated during a 3-month follow-up period. Results: The percentage of patients who showed a > 50% reduction in their VAS pain score was significantly higher in the SHP + PRF group compared to the SHP group when assessed at one month (92.9% [n = 26] vs 57.7% [n = 15]; P = .003) and 3 months (85.7% [n = 24) vs 53.8% [n = 14]; P = .01) post procedure, respectively. However, no significant difference was observed between the 2 groups at the 6-month evaluation (SHP + PRF [57.1% (n = 16)] vs SHP [50% (n = 13)]; P = .59). There was a statistically significant reduction of VAS in the SHP + PRF group in comparison to the SHP group at one month (2.8 ± 0.9 vs 3.5 ± 1.2 [mean difference, -0.7 (95% confidence interval [CI], -1.29 to -0.1), P = .01]), 2 months (2.8 ± 0.9 vs 3.5 ± 1.2 [mean difference, -0.64 (95% CI, -1.23 to -0.05), P = .03]), and 3 months (2.7 ± 1 vs 3.4 ± 1.2 [mean difference, -0.67 (95% CI, -1.29 to -0.05)], P = .03]) post procedure, respectively; however, the 2 groups did not significantly differ at 2 weeks, 4, 5, and 6 months post procedure. Regarding postprocedural analgesic consumption, there were trends towards reduced opioid consumption at all postprocedural measured time points in the SHP+PRF group compared to the SHP group; these differences reached statistical significance at 2 months (median, 30 [interquartile range (IQR), 0.00-30] vs median, 45 [IQR, 30-90]; P = .046) and 3 months (median, 0.00 [IQR, 0.00-30] vs median, 30 [IQR, 0.00-67.5]; P = .016) post procedure, respectively. Limitations: The study follow-up period is limited to 6 months only. Conclusions: SHP-N combined with PRF of the sacral roots (S2, 3, 4) provided a better analgesic effect than SHP-N alone for patients with chronic pelvic and perineal pain related to pelvic cancer. Trial Registry: ClinicalTrials.gov. NCT03228316. Key words: Pelvic pain, pulsed radiofrequency, sacral roots, superior hypogastric plexus

Superior Hypogastric Plexus Block for Pelvic Cancer Pain

1990 ◽  
Vol 73 (2) ◽  
pp. 236-239 ◽  
Author(s):  
Ricardo Plancarte ◽  
Cesar Amescua ◽  
Richard B. Patt ◽  
J. Antonio Aldrete
Keyword(s):  
Cancer Pain ◽  
Hypogastric Plexus ◽  
Pelvic Cancer ◽  
Superior Hypogastric Plexus ◽  
Plexus Block

scholarly journals Superior Hypogastric Plexus Combined with Ganglion Impar Neurolytic Blocks for Pelvic and/or Perineal Cancer Pain Relief

2015 ◽  
Vol 18;1 (1;1) ◽  
pp. E49-E56
Author(s):  
Doaa Gomaa Ahmed
Keyword(s):  
Cancer Pain ◽  
Pelvic Pain ◽  
Small Sample Size ◽  
Oral Morphine ◽  
Small Sample ◽  
Perineal Pain ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Neurolytic Block ◽  
Ganglion Impar

Background: The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the ganglion impar neurolysis have been described in the literature. Objectives: To assess the feasibility, safety, and efficacy of combining the block of the SHGP through the postero-median transdiscal approach with the GI block by the transsacro-coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or perineal malignancies or any cancer related causes. Methods: Fifteen patients who had cancer-related pelvic pain, perineal pain, or both received a combined SHGP neurolytic block through the postero-median transdiscal approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm needle and injection of 4 – 6 mL of 8% phenol in saline. Pain intensity (measured using a visual analogue scale) and oral morphine consumption pre- and post-procedure were measured. Results: All patients presented with cancer-related pelvic, perineal, or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to 2.40 ± 2.10 one week post-procedurally (P < 0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 98.00 ± 34.89 mg to 32.00 ± 28.48 mg after one week (P < 0.05). No complications or serious side effects were encountered during or after the block. Limitations: This study is limited by its small sample size and non-randomized study. Conclusion: A combined neurolytic SHGP block with GI block is an effective and safe technique for reducing pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach. Key words: Superior hypogastric plexus block, ganglion impar block, cancer pain, pelvic pain, perineal pain

scholarly journals The Role of Double Modality Ultrasonographic and Fluoroscopic Guided Superior Hypogastric Plexus Neurolysis in Treating Intractable Pelvic Cancer Pain: A Comparative Study

2021 ◽  
Vol Volume 14 ◽  
pp. 1465-1473
Author(s):  
Ekramy M Abdelghafar ◽  
Ahmed H Othman ◽  
Mahmoud Salem Soliman ◽  
Ayman Kilany ◽  
Mohammed H Shaaban ◽  
...  
Keyword(s):  
Comparative Study ◽  
Cancer Pain ◽  
Hypogastric Plexus ◽  
Pelvic Cancer ◽  
Superior Hypogastric Plexus

Efficacy of Superior Hypogastric Plexus Neurolysis for the Treatment of Cancer-Related Pelvic Pain

Pain Medicine ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 1255-1262 ◽  
Author(s):  
Saiyun Hou ◽  
Diane Novy ◽  
Francis Felice ◽  
Dhanalakshmi Koyyalagunta
Keyword(s):  
Pelvic Pain ◽  
Rating Scale ◽  
Symptom Burden ◽  
Assessment System ◽  
Cancer Center ◽  
Safe Procedure ◽  
Pelvic Malignancies ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus

Abstract Objective Cancer-related abdominal and pelvic pain syndromes can be debilitating and difficult to treat. The objective of this study was to evaluate the efficacy of superior hypogastric plexus blockade or neurolysis (SHPN) for the treatment of cancer-related pelvic pain. Design Retrospective study. Setting MD Anderson Cancer Center, Houston, Texas. Methods We enrolled 46 patients with cancer-related pelvic pain who underwent SHPN. A numeric rating scale (NRS) was used for pain intensity, and symptom burden was evaluated using the Edmonton Symptom Assessment System at baseline, visit 1 (within one month), and visit 2 (within one to six months). Results Forty-six patients who received SHPN showed a significant reduction in pain score from 6.9 to 5.6 at visit 1 (P = 0.01). Thirty of the 46 patients continued to complete visit 2 follow-up, and the NRS score was consistently lower at 4.5 at visit 2 (P &lt; 0.0001), with anxiety and appetite improved significantly. There was no significant change in the morphine equivalent dose at visits 1 and 2. The efficacy of the block was not influenced by patients’ age, gender, type of cancer, cancer stage, regimen of chemotherapy and/or radiation therapy, diagnostic block, approach or laterality of procedure, or type or amount of neurolytic agent. Nonsmokers with high baseline pain scores were more likely to have improved treatment outcomes from SHPN at short-term follow-up. Adverse effects with SHPN were mild and well tolerated. Conclusions SHPN was an effective and relatively safe procedure for pain associated with pelvic malignancies. There is a need for larger prospective trials.

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