Cancer pain management: Part II: Interventional techniques

Interventional Techniques for the Management of Cancer-Related Pain: Clinical and Critical Aspects

“…General contraindications for neurolytic blocks of sympathetic pathways include tumor invasion into the insertion site, coagulopathy, systemic or localized infection, complicated anatomy, and bowel obstruction [2,48]. Reported complications are back pain, orthostatic hypotension, diarrhea, retroperitoneal hematoma, bladder or ureteral injury, and inadvertent somatic nerve damage [2,48]. Different from neurolytic somatic blocks, CPB is claimed to be safe because neurological complications are unlikely and mostly transient when performed with CT guidance.…”

“…However, this intervention causes an irreversible disruption of the nervous conduction and, therefore, risks and consequences should be examined carefully. The selection of patients with cancer for this procedure is based on presence of malignant unilateral pain refractory to systemic treatment and other nondestructive interventions, life expectancy of few years or less considering the possibility of pain recurrence (lesioned nerves may regrow, and neuropathic pain may return), and anatomic location of the intervention that permits a safe procedure [2,57]. It is recommended to treat unilateral pain caused by malignant pleural mesothelioma, breast cancer, brachial plexus pain related to pancoast tumor pressure/infiltration, or unilateral leg pain.…”

“…The interruption of nociceptive pathways at peripheral and central levels can be an alternative treatment approach for patients with cancer-related pain. It can be done by interventional nondestructive or neuroablatory techniques and is particularly indicated for the management of cancer-related pain with an unsatisfactory response to strong systemic opioids and adjuvant analgesics and/or in patients with intolerable side effects of systemic analgesics [2]. Such pain is often referred to as refractory pain.…”

“…Moreover, interventional techniques imply risks for complications. Therefore, potential benefits and harms should be considered for each patient [2].…”

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

“…The ganglion impar (also known as the ganglion of Walther) is located anterior to the sacrococcygeal junction. 55 It is the solitary, distal termination of the bilateral sympathetic chains. This ganglion innervates the distal rectum, anus, and perineum.…”