Efficacy of the Anterior Ultrasound-Guided Superior Hypogastric Plexus Neurolysis in Pelvic Cancer Pain in Advanced Gynecological Cancer Patients

Abstract

The anterior USG-guided superior hypogastric plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided superior hypogastric block.

Sympathetic blocks for visceral cancer pain management: A systematic review and EAPC recommendations

“…SHPB produced a significant decrease in pain intensity and a less morphine consumption in comparison with pharmacological approach, while no statistical differences in adverse effects were found (Mishra et al, 2013). Pelvic pain is even more complex than pancreatic pain, for which CPB is performed, and often multiple pain mechanisms are involved.Somatic pain and neuropathic pain often coexist and mixed syndromes are more likely to be observed in patients with pelvic tumors than in those with abdominal pain caused by pancreatic cancer (Mercadante et al, 2002).…”

“…Mishra et al, (Mishra et al, 2013) randomized fifty patients with pelvic cancer pain associated with gynaecological cancer to receive either ultrasound-guided SHPB and oral morphine or oral morphine only. Patients treated with the block had a decrease in pain intensity and a less morphine consumption, while no statistical differences in adverse effects were found.…”

Management of cyclical pelvic pain by multiple ultrasound-guided superior hypogastric plexus blocks in a rare case of Mayer-Rokitansky-Küster-Hauser syndrome - A case series of three blocks in a patient

“…Other disadvantages include radiation hazards, discitis in a transdiscal approach, and inability to identify vascular and other peritoneal structures. Recently an ultrasound-guided technique for SHPB has been described for patients with cancer (10). The procedure was verified in a cadaveric study and confirmed using fluoroscopy (11).…”

Effectiveness of Superior Hypogastric Plexus Block for Pain Control Compared to Epidural Anesthesia in Women Requiring Uterine Artery Embolization for the Treatment of Uterine Fibroids – A Retrospective Evaluation

“…It is known that SHPB prevents transmission of pelvic pain signals to the central nervous system. Previous studies showed reduced pain and morphine consumption with SHPB compared to placebo or sham treatment in women with gynecologic cancer [4] and in those who underwent hysterectomy [5] or UAE [6]. Furthermore, a single-center, retrospective evaluation of UAE patients revealed lower peroral morphine-equivalent consumption with SHPB compared to EDA [7].…”