Efficacy and Safety of Neurolytic Splanchnic Nerve Block via Transintervertebral Disc Approach to Retrocrural Space: A Multicenter Retrospective Study

Abstract

Introduction Celiac plexus block is effective for treating intractable cancer pain and has been the focus of many studies. Several guiding techniques such as fluoroscopy, computed tomography, and endoscopy have been devised, and the target of the block has varied in previous studies as both the celiac plexus and splanchnic nerve, which is the main origin of the celiac plexus, have been targeted. At our affiliated institution, fluoroscopy-guided splanchnic nerve block with a single needle via transintervertebral disc approach is the first choice. However, there have been few reports on the use of this technique. This study investigated the efficacy and safety of this technique. Methods This multicenter retrospective observational study reviewed the medical records of patients who underwent neurolytic splanchnic nerve block (NSNB) via transintervertebral disc approach for intractable cancer pain at five tertiary hospitals in Japan from April 2005 to October 2020. The primary outcome was the clinical success ratio of NSNB, and the secondary outcome was the incidence ratio of NSNB-related adverse events. Results In total, 103 patients were included in the analysis. Of these, 77 patients met the definition of clinical success, with a ratio of 74.8%. The incidence ratio of NSNB-related adverse events was 40.8% (hypotension, 21.4%; alcohol intoxication, 13.6%; diarrhea, 11.7%; and vascular puncture, 3.9%; duplicates were present). All adverse events improved with observation and symptomatic treatment only. No patient had infection or serious adverse events such as organ or nerve damage. Conclusions The clinical success ratio of this technique was 74.8%. Although the incidence of adverse events was 40.8%, all events were mild and no serious adverse events were observed. The findings demonstrate the efficacy and safety of our NSNB in patients with intractable cancer pain.

Long-Term Analgesic Efficacy of Neurolytic Splanchnic Nerve Block via the Transintervertebral Disc Approach to Retrocrural Space: A Multicenter Retrospective Study

“…We performed NSNB using a standardized, fluoroscopically-guided, transintervertebral disc approach to the retrocrural space with a single needle, which is presented in our previous article [ 14 ]. Patients indicated for NSNB were those who consulted anesthesiologists at each institution for the control of cancer pain.…”

“…We also defined the time of NRS augmentation as the date when the post-block NRS score first became higher than the pre-block NRS score, and investigated the number of days since the block at that time. Baseline and pain characteristics and post-block data including clinical success, which we defined as more than 50% reduction in lowest NRS score without opioid escalation within 14 days after block [ 14 ], post-block duration of survival, and absolute alcohol (neurolytic agent) dose were compared between NRS augmentation (+) and (–) groups. In addition, baseline and pain characteristics and post-block data were compared between clinically unsuccessful and successful groups.…”

“…Therefore, we investigated the efficacy and safety of fluoroscopy-guided neurolytic splanchnic nerve block (NSNB) via the transintervertebral disc approach with a single needle. Our study showed that the clinical success ratio of this technique was 74.8%, and all adverse events were mild, with no serious complications [ 14 ]. However, our study had only short-term results within 14 days after the block.…”

“…The purpose of this study was to investigate the long-term analgesic efficacy of NSNB via the transintervertebral disc approach under fluoroscopic guidance after a single NSNB. We used the same database of our previous study [ 14 ]. In contrast to our previous study, which showed only the short-term efficacy within 14 days [ 14 ], in this study we investigated the long-term analgesic efficacy at 1, 2, 3, and 6 months after NSNB.…”

“…We used the same database of our previous study [ 14 ]. In contrast to our previous study, which showed only the short-term efficacy within 14 days [ 14 ], in this study we investigated the long-term analgesic efficacy at 1, 2, 3, and 6 months after NSNB.…”