Radiofrequency Ablation of the Splanchnic Nerve and Superior Hypogastric Plexus for Chronic Abdominal Pain Status Post-Abdominal Surgery

AbstractBackground and aimsBariatric surgery remains a mainstay for treatment of morbid obesity. However, long-term adverse outcomes include chronic abdominal pain and persistent opioid use. The aim of this review was to assess the existing data on prevalence, possible mechanisms, risk factors, and outcomes regarding chronic abdominal pain and persistent opioid use after bariatric surgery.MethodsPubMed was screened for relevant literature focusing on chronic abdominal pain, persistent opioid use and pharmacokinetic alterations of opioids after bariatric surgery. Relevant papers were cross-referenced to identify publications possibly not located during the ordinary screening.ResultsEvidence regarding general chronic pain status after bariatric surgery is sparse. However, our literature review revealed that abdominal pain was the most prevalent complication to bariatric surgery, presented in 3–61% of subjects with health care contacts or readmissions 1–5 years after surgery. This could be explained by behavioral, anatomical, and/or functional disorders. Persistent opioid use and doses increased after bariatric surgery, and 4–14% initiated a persistent opioid use 1–7 years after the surgery. Persistent opioid use was associated with severe pain symptoms and was most prevalent among subjects with a lower socioeconomic status. Alteration of absorption and distribution after bariatric surgery may impact opioid effects and increase the risk of adverse events and development of addiction. Changes in absorption have been briefly investigated, but the identified alterations could not be separated from alterations caused solely by excessive weight loss, and medication formulation could influence the findings. Subjects with persistent opioid use after bariatric surgery achieved lower weight loss and less metabolic benefits from the surgery. Thus, remission from comorbidities and cost effectiveness following bariatric surgery may be limited in these subjects.ConclusionsPain, especially chronic abdominal, and persistent opioid use were found to be prevalent after bariatric surgery. Physiological, anatomical, and pharmacokinetic changes are likely to play a role. However, the risk factors for occurrence of chronic abdominal pain and persistent opioid use have only been scarcely examined as have the possible impact of pain and persistent opioid use on clinical outcomes, and health-care costs. This makes it difficult to design targeted preventive interventions, which can identify subjects at risk and prevent persistent opioid use after bariatric surgery. Future studies could imply pharmacokinetic-, pharmacodynamics-, and physiological-based modelling of pain treatment. More attention to social, physiologic, and psychological factors may be warranted in order to identify specific risk profiles of subjects considered for bariatric surgery in order to tailor and optimize current treatment recommendations for this population.

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Use of methylene blue in the prevention of recurrent intra-abdominal postoperative adhesions

Journal of International Medical Research ◽

10.1177/0300060517727694 ◽

2017 ◽

Vol 46 (1) ◽

pp. 504-510 ◽

Cited By ~ 2

Author(s):

Octavian C. Neagoe ◽

Mihaela Ionica ◽

Octavian Mazilu

Keyword(s):

Methylene Blue ◽

Abdominal Pain ◽

Abdominal Surgery ◽

Beneficial Effect ◽

Adhesion Formation ◽

Chronic Abdominal Pain ◽

Postoperative Adhesions ◽

Similar Time ◽

History Of

Objective To evaluate the efficacy of methylene blue in preventing recurrent symptomatic postoperative adhesions. Methods Patients with a history of >2 surgeries for intra-abdominal adhesion-related complications were selected for this study. Adhesiolysis surgery was subsequently performed using administration of 1% methylene blue. The follow-up period was 28.5 ± 11.1 months. Results Data were available from 20 patients (seven men and 13 women) whose mean ± SD age was 51.2 ± 11.4 years. Adhesions took longer to become symptomatic after the first abdominal surgery when the initial pathology was malignant compared with benign. However, the recurrence of adhesions after a previous adhesiolysis surgery had a similar time onset regardless of the initial disease. Following adhesiolysis surgery with methylene blue, the majority of patients did not present with symptoms associated with adhesion complications (i.e., chronic abdominal pain, bowel obstruction) for the length of the follow-up period. Conclusions The use of methylene blue during adhesiolysis surgery appears to reduce the recurrence of adhesion-related symptoms, suggesting a beneficial effect in the prevention of adhesion formation.

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Implantation of an intercostal nerve stimulator for chronic abdominal pain

Annals of The Royal College of Surgeons of England ◽

10.1308/147870810x12659688851474 ◽

2010 ◽

Vol 92 (3) ◽

pp. e1-e3 ◽

Cited By ~ 1

Author(s):

RD Johnson ◽

AL Green ◽

TZ Aziz

Keyword(s):

Abdominal Pain ◽

Abdominal Surgery ◽

Intercostal Nerve ◽

Chronic Abdominal Pain ◽

Laparoscopic Appendicectomy ◽

Nerve Stimulator ◽

First Report ◽

History Of

Chronic abdominal pain is not uncommon and can be difficult to manage. We present the case of a 17-year-old man with a 4-year history of chronic abdominal pain. The patient had previously undergone abdominal surgery by way of laparoscopic appendicectomy and right nephrectomy for a mal-rotated kidney. The patient continued to suffer right-sided abdominal pain which was not controlled by analgesia. We report the successful implantation of a right D11 intercostal nerve stimulator to control the patient’s pain. This is the first report of an implantable intercostal nerve stimulator to control intractable chronic abdominal pain.

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