title: Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients.
abstract: OBJECTIVE
  Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in gynecological cancer patients.
  
  
  METHODS
  The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided superior hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects.
  
  
  RESULTS
  There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P < 0.05) greater. The daily morphine consumption in Group II decreased throughout the study, and more patients in Group II improved in their functional capacity, although it was statistically insignificant. It was observed that global satisfaction scores were better in Group II during the initial first (P = 0.001) week and 1 month (P = 0.04) compared with Group I.
  
  
  CONCLUSIONS
  The anterior USG-guided superior hypogastric plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided superior hypogastric block.
authors.affiliation: Unit of Anaesthesiology, Dr. B.R.Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. seemamishra2003@gmail.com
authors.forename: Seema
authors.initials: S
authors.lastname: Mishra
authors.forename: Sushma
authors.initials: S
authors.lastname: Bhatnagar
authors.forename: Shiv P S
authors.initials: SP
authors.lastname: Rana
authors.forename: Deepa
authors.initials: D
authors.lastname: Khurana
authors.forename: Sanjay
authors.initials: S
authors.lastname: Thulkar
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007001:Hypogastric Plexus / Q000187:drug effects*; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine