Current Indications of Neurolytic Blocks in Cancer Pain

Nicosia, Francesco M.; Mercadante, Sebastiano

doi:10.1007/s11916-998-0016-3

Cited by 1 publication

(2 citation statements)

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“…Typically, neurolytic blocks are performed later in the course of disease when side effects from oral drugs become intolerable or conventional oral pharmacotherapy fails to adequately address the issue of pain 9 . There is no specific consensus regarding indications and timing for application of these blocks 16 . Recently, this issue of timing has been revisited and authors are suggesting an early role for neurolysis 5 …”

Section: Discussionmentioning

confidence: 99%

“…Ganglion impar neurolysis (GIN) works best for poorly localized peri‐anal pain that is frequently accompanied by sensations of burning and tenesmus. However, indications for and timing of application of neurolytic blocks remain obscure at the best 16 . Although a variety of techniques have been described for performing celiac plexus, 17–24 superior hypogastric plexus 25–30 and ganglion impar block, 31–36 ultrasonography (USG)‐guided techniques offer the convenience of bedside performance of these blocks 8,13,15 .…”

Section: Introductionmentioning

confidence: 99%

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Early Ultrasound‐Guided Neurolysis for Pain Management in Gastrointestinal and Pelvic Malignancies: An Observational Study in a Tertiary Care Center of Urban India

Bhatnagar¹,

Khanna²,

Roshni³

et al. 2011

Pain Practice

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Patients with advanced gastrointestinal and pelvic malignancies commonly present with pain of varying severity. In a majority of these patients, pain can be effectively managed using an integrated systemic pharmacological approach with oral morphine being the cornerstone of treatment. However, with escalating doses, intolerable side effects of oral morphine may lead to patient dissatisfaction. When oral pharmacotherapy fails to adequately address the issue of pain or leads to insufferable side effects, neurolytic blocks of the sympathetic axis are usually used for pain alleviation. As these blocks may reduce oral analgesic requirement, a reevaluation of their timing is merited. This article presents our hospital-based in-patient palliative care unit experience with early ultrasonography-guided neurolysis of celiac plexus, superior hypogastric plexus and ganglion impar. Of the 44 patients we studied, 20 underwent celiac plexus neurolysis, 18 superior hypogastric plexus neurolysis, and 6 ganglion impar neurolysis. Their pain was being managed with oral morphine before neurolysis, but only 11.4% patients required oral morphine for satisfactory pain control, 2 months after neurolysis. The mean Visual Analog Scale score before block placement was 5.64 ± 0.69 and fell to 2.25 ± 1.33 at 2 months post neurolysis (P < 0.001). We suggest that bedside ultrasonography-guided sympathetic axis neurolysis may be employed early in patients with incurable abdominal or pelvic cancer. Its use as a first-line intervention for achieving pain control with minimal complications warrants further consideration and investigation.

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Section: Discussionmentioning

confidence: 99%