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 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

scholarly journals Chemical Neurolysis of the Inferior Hypogastric Plexus for the Treatment of Cancer-Related Pelvic and Perineal Pain

2013 ◽  
Vol 18 (5) ◽  
pp. 249-252 ◽  
Author(s):  
Sahar Abd-Elbaky Mohamed ◽  
Doaa Gomaa Ahmed ◽  
Mohamad Farouk Mohamad
Keyword(s):  
Oral Morphine ◽  
Good Alternative ◽  
Perineal Pain ◽  
Inferior Hypogastric Plexus ◽  
Patients With Cancer ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Chronic Pain Conditions ◽  
Ganglion Impar Block ◽  
Plexus Block

BACKGROUND: Various interventions, including the superior hypogastric plexus block and ganglion impar block, are commonly used for the treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block (performed using a trans-sacral approach under fluoroscopy and using a local anesthetics/steroid combination) for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described in 2007. Neurolysis of the inferior hypogastric plexus may be useful for the treatment of pelvic and perineal pain caused by cancer.OBJECTIVES: To assess the feasibility, safety and efficacy of the newly introduced inferior hypogastric plexus block, performed using a trans-sacral approach, for the relief of cancer-related pelvic and perineal pain.METHODS: A total of 20 patients with cancer pain in the pelvis and/or perineum were injected with 6 mL to 8 mL of 10% phenol bilaterally by passing a spinal needle through the sacral foramen to perform the inferior hypogastric block. Pain intensity (measured using a visual analogue scale), sleep score, activity score, psychological score and oral morphine consumption pre- and postprocedure were measured.RESULTS: Two of the 20 patients died during the follow-up period and were, therefore, excluded from the study. All patients presented with cancer-related pelvic, perineal or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.22±1.31 preprocedurally to 4.06±1.73 one week postprocedurally (P<0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 106.67±32.90 mg to 61.67±40.48 mg after one week (P<0.05). No complications or serious side effects were encountered during or after the block.DISCUSSION AND CONCLUSION: The approach provides a good alternative technique for the treatment of low pelvic and perineal cancer-related pain. Additional studies are required for evaluation and refinement of the technique using other radiological techniques.

scholarly journals RETROGRADE EJACULATION FOLLOWING LUMBOPELVIC SYMPATHETIC NEUROLYSIS – A CASE SERIES

2017 ◽  
pp. 133-142
Author(s):  
Ajax Yang
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Case Series ◽  
Retrograde Ejaculation ◽  
Potential Consequence ◽  
Careful Evaluation ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Male Patients ◽  
Ganglion Impar

Background: Sympathetic neurolysis, or sympathectomy, is an established modality for the treatment of chronic pain. In cases of chronic pelvic pain (CPP), the ganglion of impar (GI) and the superior hypogastric plexus (SHP) are widely accepted targets for such therapy. Objective: While diagnostic injections typically predate any neurolysis for the purpose of ascertaining any potential effi cacy for interrupting a particular pathway, careful attention is equally paid to evaluate for possible adverse events - in the case of lumbopelvic neurolysis, retrograde ejaculation (RE) is one such possibility. Study Design: A case series. Setting: An outpatient pain management clinic. Methods: We present 3 male patients with CPP treated who underwent neurolytic procedures targeting the GI and SHP. Results: The fi rst patient developed RE after undergoing a simultaneous neurolysis of both the SHP and GI, in the same sitting. The second and third patients both experienced temporary RE immediately after diagnostic blockades of the SHP, following GI neurolysis that was performed several weeks prior. Limitations: Cause-effect conclusions cannot be drawn from the results of a case series. Conclusions: RE is a potential consequence of combined or serial SHP and GI neurolysis. While neurolysis of either the GI or SHP individually have not been known to cause RE in men, this case series demonstrates the potential risk in causing it when both structures are simultaneously incapacitated in some form; as such, the authors recommend against both structures being ablated or disabled concurrently without careful evaluation with temporary blockades fi rst. In an effort to avoid such a complication or evaluate for the possibility in a particular individual, we recommend that an individual with CPP, who has already been treated with a neurolysis, undergoes diagnostic blocks fi rst on whichever of the 2 structures has not yet been ablated to carefully evaluate if RE will occur. Key words: Retrograde ejaculation, superior hypogastric plexus, ganglion impar; neurolysis, chronic pelvic pain, male infertility, diagnostic block

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 Effectiveness of the superior hypogastric plexus neurolytic block in the management of pelvic abdominal pain in adult patients diagnosed with cancer: A systematic literature review

2020 ◽  
Vol 49 (6) ◽  
Author(s):  
Diana P Pérez-Moreno Pérez-Moreno ◽  
Ricardo Plancarte-Sánchez ◽  
Carolina Hernández-Porras ◽  
María del Rocío Guillén-Núñez
Keyword(s):  
Quality Of Life ◽  
Pelvic Pain ◽  
Adult Patients ◽  
Inclusion Criteria ◽  
Hypogastric Plexus ◽  
Language Restriction ◽  
Superior Hypogastric Plexus ◽  
Neurolytic Block ◽  
Positive Results

Introduction: Severe oncological pain occurs in up to 60% of pelvic abdominal cáncer patients, being refractory to medical management in up to 30% of cases. In 1990, the superior hypogastric plexus neurolytic block (SHPB) was described for the control of pain in these patients. This study aimed to evaluate the effectiveness of this technique for the control of oncological pain. Methodology: Studies that evaluated the effectiveness of the SHPB using the classic or transdiscal approach in adult patients with oncological abdominal-pelvic pain were systematically reviewed. A search was conducted in PubMed, EMBASE and Scopus from January 1, 1990, to August 31, 2019, without a language restriction. The visual analog scale (VAS), morphine milligram equivalents (MME) per day, quality of life and presence of complications were recorded. The quality of the studies was evaluated using the Jadad and Ottawa-Newcastle scales. Results: Eight studies met the inclusión criteria: 6 were descriptivo longitudinal studies, and 2 were controlled clinical trials, comprising 316 patients (75% female and 25% male; average age 53.2 years); the most frequent diagnoses were gynecological (65%) cancer. An average VAS reduction of 55%-60.8% was obtained as well as a MME reduction of 40%-60%. Three studies evaluated the quality of life using the (QLQ-C30), (PSS) and Zubrod scale all with positive results. Complications were reported in 18% of cases, pain related to the puncture was the most frequent. Conclusions: The SHPB may be an effective for the control of severe oncological abdominal-pelvic pain, decreasing the VAS and MME and improving the quality of life of patients.

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.

Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer

Pain ◽  
1993 ◽  
Vol 54 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Oscar A. de Leon-Casasola ◽  
Edward Kent ◽  
Mark J. Lema
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Hypogastric Plexus ◽  
Superior Hypogastric Plexus ◽  
Plexus Block
Sign in / Sign up

Export Citation Format

Share Document