title: Sympathetic blocks for visceral cancer pain management: A systematic review and EAPC recommendations.
abstract: The neurolytic blocks of sympathetic pathways, including celiac plexus block (CPB) and superior hypogastric plexus block (SHPB) , have been used for years. The aim of this review was to assess the evidence to support the performance of sympathetic blocks in cancer patients with abdominal visceral pain. Only comparison studies were included. All data from the eligible trials were analyzed using the GRADE system. Twenty-seven controlled studies were considered. CPB, regardless of the technique used, improved analgesia and/or decrease opioid consumption, and decreased opioid-induced adverse effects in comparison with a conventional analgesic treatment. In one study patients treated with superior hypogastric plexus block (SHPB) had a decrease in pain intensity and a less morphine consumption, while no statistical differences in adverse effects were found. The quality of these studies was generally poor due to several limitations, including sample size calculation, allocation concealment, no intention to treat analysis. However, at least two CPB studies were of good quality. Data regarding the comparison of techniques or other issues were sparse and of poor quality, and evidence could not be analysed. On the basis of existing evidence, CPB has a strong recommendation in patients with pancreatic cancer pain. There is a weak recommendation for SHPB, that should be based on individual conditions. Data regarding the choice of the technique are sparse and unfit to provide any recommendation.
authors: Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy; Department Anesthesia, Intensive Care & Emergencies, University of Palermo, Italy. Electronic address: sebelle@gmail.com.
authors: Sebastiano
authors: S
authors: Mercadante
authors: Department Intensive Care Medicine, St. Olavs University Hospital, Trondheim, Norway; Department Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: pal.klepstad@ntnu.no.
authors: Pål
authors: P
authors: Klepstad
authors: Section of Palliative Medicine, Department Oncology, Rigshospitalet-Copenhagen University Hospital, Denmark; Multidisciplinary Pain Centre, Department Neuroanaesthesiology, Rigshospitalet-Copenhagen University Hospital, Denmark. Electronic address: geana@rh.regionh.dk.
authors: Geana Paula
authors: GP
authors: Kurita
authors: Department Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Section of Palliative Medicine, Department Oncology, Rigshospitalet-Copenhagen University Hospital, Denmark. Electronic address: per.sjoegren@regionh.dk.
authors: Per
authors: P
authors: Sjøgren
authors: Chair of Anesthesiology, Intensive care and pain therapy, University of Palermo, Italy. Electronic address: giarratano@unipa.it.
authors: Antonino
authors: A
authors: Giarratano
mesh_terms: D000008:Abdominal Neoplasms / Q000150:complications*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001340:Autonomic Nerve Block; D005060:Europe; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D017410:Practice Guidelines as Topic
chemical_list: D000701:Analgesics, Opioid
keywords: Cancer pain; Celiac plexus block; Opioids; Superior hypogastric plexus block; Sympathetic blocks