[Transdiscal percutaneous approach of splanchnic nerves].
Neurolytic celiac plexus block is an established, well-developed procedure and the most accepted and applied in visceral pain; recognized by the WHO and the IASP, it is very good in palliative management of cancer pain in visceral of superior hemiabdomen. However, conventional techniques in celiac plexus have not been successful in patients with organomegaly and/or anatomic abnormalities, except when splanchnic nerve neurolytic blockade is used. On the other hand, conventional techniques in splanchnic nerves are highly associated with complications such as paraplegia, pneumothorax and liver or renal punction. For these reasons an alternative option has ben designed, termed transdiscal percutaneous approach of splanchnic nerves under tomographic control; this technique affords the option of improving accuracy and performance with minimum risks, particularly lung puncture and its consequences. Under this technique, 64 superior hemi-abdomen cancer patients initiated such a study (four without morphine treatment quit the study), 55% females and 45% males, visceral pain syndrome 65%, and mixed, 35%. Side effects were dyspnea 5%, hypotension 26.7%, nausea 31.7%, diarrhea 83.3% in which diarrhea means increased peristalsis showing adequate sympathetic inhibition via splanchnic nerves), vomiting 28.3%, punction-site pain 46.7%, aorta punction 6.7%, anal pleural punction 5%. All these incidents were dealt with by conservative treatment. Student t test showed that pain intensity in all measurements after procedure was different in comparison to basal pain intensity prior to procedure (p<0.05), emphasizing that at the 12th, 18th and 24th months, there was noticeable reduction in participants number with eight, five and four participants, respectively. Morphine intake at week 1, and 1, 2, 3, 6 and 12 months after procedure was different from basal intake prior to procedure (p<0.05) with same noticeable reduction in participant numbers at last stages. Butylhioscine intake at week 1, 1, 2, 3 and 6 months after procedure was different from basal intake prior to procedure (p<0.05). NSAIDs consumption was likely during 2 months after procedure (p<0.05). Linear regression showed that butylhioscine and morphine explained low percentage of pain intensity variance, controlling statistically that effect over pain. There were no differences in pain pathophysiology with regard to cancer type. Transdiscal percutaneous approach of splanchnic nerves guided by CAT is an alternative with minimal risks, as with lung punction, confirming that inhibiting splanchnic nerves has advantages in pain release, reducing and/or eliminating morphine consumption.
Plancarte-Sánchez
Ricardo
R
Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Cancerología, México DF. planky@data.net.mx
Máyer-Rivera
Francisco
F
del Rocío Guillén Núñez
Ma
M
Guajardo-Rosas
Jorge
J
Acosta-Quiroz
Christian Oswaldo
CO
D000008:Abdominal Neoplasms / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013153:Splanchnic Nerves; D013904:Thoracic Vertebrae