Management of chronic upper abdominal pain in cancer: transdiscal blockade of the splanchnic nerves.
BACKGROUND
The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief.


METHODS
The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction.


RESULTS
Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed.


CONCLUSIONS
Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications.
Clinic of Pain and Palliative Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico. planky2b@yahoo.com.mx
Ricardo
R
Plancarte
Jorge
J
Guajardo-Rosas
David
D
Reyes-Chiquete
Faride
F
Chejne-Gómez
Andrea
A
Plancarte
Nadia I
NI
González-Buendía
Oscar
O
Cerezo-Camacho
Angel
A
Lee
Roberto
R
Medina-Santillan
D000005:Abdomen / Q000294:innervation*; D000008:Abdominal Neoplasms / Q000150:complications*; D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging; D008137:Longitudinal Studies; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D015641:Radiography, Interventional; D013153:Splanchnic Nerves; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid