Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves

Ricardo Plancarte, Jorge Guajardo-Rosas, David Reyes-Chiquete, Faride Chejne-Gómez, Andrea Plancarte, Nadia I. González-Buendía, Oscar Cerezo-Camacho, Ángel Lee, Roberto Medina-Santillan

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Abstract

Background: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. MATERIALS AND Methods: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction. Results: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed. Conclusions: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications. Copyright © 2010 by American Society of Regional Anesthesia and Pain Medicine.
Original languageAmerican English
Pages (from-to)500-506
Number of pages449
JournalRegional Anesthesia and Pain Medicine
DOIs
StatePublished - 1 Nov 2010

Fingerprint

Splanchnic Nerves
Nerve Block
Abdominal Pain
Tomography
cancer
Celiac Plexus
Pain
relief
Morphine
Analgesics
Neoplasms
Paraparesis
Intractable Pain
Esophageal Neoplasms
Mexico
Patient Satisfaction
Hypotension
Analgesia
Opioid Analgesics
Diarrhea

Cite this

Plancarte, Ricardo ; Guajardo-Rosas, Jorge ; Reyes-Chiquete, David ; Chejne-Gómez, Faride ; Plancarte, Andrea ; González-Buendía, Nadia I. ; Cerezo-Camacho, Oscar ; Lee, Ángel ; Medina-Santillan, Roberto. / Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves. In: Regional Anesthesia and Pain Medicine. 2010 ; pp. 500-506.
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title = "Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves",
abstract = "Background: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. MATERIALS AND Methods: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerolog{\'i}a in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction. Results: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed. Conclusions: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications. Copyright {\circledC} 2010 by American Society of Regional Anesthesia and Pain Medicine.",
author = "Ricardo Plancarte and Jorge Guajardo-Rosas and David Reyes-Chiquete and Faride Chejne-G{\'o}mez and Andrea Plancarte and Gonz{\'a}lez-Buend{\'i}a, {Nadia I.} and Oscar Cerezo-Camacho and {\'A}ngel Lee and Roberto Medina-Santillan",
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Plancarte, R, Guajardo-Rosas, J, Reyes-Chiquete, D, Chejne-Gómez, F, Plancarte, A, González-Buendía, NI, Cerezo-Camacho, O, Lee, Á & Medina-Santillan, R 2010, 'Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves', Regional Anesthesia and Pain Medicine, pp. 500-506. https://doi.org/10.1097/AAP.0b013e3181fa6b42

Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves. / Plancarte, Ricardo; Guajardo-Rosas, Jorge; Reyes-Chiquete, David; Chejne-Gómez, Faride; Plancarte, Andrea; González-Buendía, Nadia I.; Cerezo-Camacho, Oscar; Lee, Ángel; Medina-Santillan, Roberto.

In: Regional Anesthesia and Pain Medicine, 01.11.2010, p. 500-506.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves

AU - Plancarte, Ricardo

AU - Guajardo-Rosas, Jorge

AU - Reyes-Chiquete, David

AU - Chejne-Gómez, Faride

AU - Plancarte, Andrea

AU - González-Buendía, Nadia I.

AU - Cerezo-Camacho, Oscar

AU - Lee, Ángel

AU - Medina-Santillan, Roberto

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. MATERIALS AND Methods: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction. Results: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed. Conclusions: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications. Copyright © 2010 by American Society of Regional Anesthesia and Pain Medicine.

AB - Background: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief. MATERIALS AND Methods: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction. Results: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed. Conclusions: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications. Copyright © 2010 by American Society of Regional Anesthesia and Pain Medicine.

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Plancarte R, Guajardo-Rosas J, Reyes-Chiquete D, Chejne-Gómez F, Plancarte A, González-Buendía NI et al. Management of chronic upper abdominal pain in cancer: Transdiscal blockade of the splanchnic nerves. Regional Anesthesia and Pain Medicine. 2010 Nov 1;500-506. https://doi.org/10.1097/AAP.0b013e3181fa6b42