Fluoroscopic anterior approach versus ultrasound guided superior hypogastric plexus neurolysis in cancer pelvic pain: a randomized controlled study

Abstract

Background Cancer-related pelvic pain can be difficult and debilitating to treat. Superior hypogastric plexus neurolysis (SHPN) is a good choice for adequate pain relief with fewer side effects. The current study compared between fluoroscopic anterior approach and ultrasound guided SHPN in the management of cancer-related pelvic pain. Methods Patients were randomly allocated into two equal groups. The ultrasound group (US group) (n = 48) received SHPN by an ultrasound-guided anterior approach using 3 ml 5% bupivacaine plus 20 ml 10% phenol, while the fluoroscopy group (n = 48) received SHPN by a fluoroscopy-guided anterior approach using 3 ml 5% bupivacaine plus 20 ml 10% phenol. Results The time of the procedure was shorter in the fluoroscopic group (21.31 ± 4.79 min) than the US group (24.88 ± 6.02 min) (P = 0.002). Patient satisfaction was higher in the fluoroscopy group (5.38 ± 1.482) than the US group (2.98 ± 1.495) (P˂0.001). The need for analgesia using morphine was significantly limited in each group, at 1, 2 and 3 months intervals (P1˂0.001, P2 ˂0.001 and P3 ˂0.001). There were statistically significant differences between both groups regarding fatigue at baseline, drowsiness at 3 months, nausea and vomiting at 1, 2 and 3 months and anorexia at 3 months. Group comparison also revealed statistically significant differences regarding depression at one month, anxiety at 2 and 3 months and insomnia at baseline. Conclusion The fluoroscopic anterior approach SHPN was more superior than the US guided SHPN regarding the time of the procedure and patient satisfaction, while both technique were similar regarding the numeric rating scale and the complications during block. Trial registration Registered in the ClinicalTrials.gov (Identifier: NCT05299047) at 28/03/2022.

Pain management in cervical cancer

“…Technological advances have led to novel pain management techniques, such as ultrasonography in SHPN, proving safer for cancer pain patients ( 23 , 67 ). Similar pain relief and a lower rate of severe side effects have been observed using ablative radiofrequency compared to chemical neurolysis for sacral nerve pain ( 42 ).…”

The pros and cons of ultrasound-guided procedures in pain medicine

“…The procedure in category 4 is challenging under US guidance, and only one prospective comparative study is designated in this category. Abdelghaffar and Farahat [ 28 ] conducted a randomized study comparing the US and FL for superior hypogastric plexus neurolysis in 96 patients with cancer-related pelvic pain, with the results showing the procedure time being longer using US (24 minutes) than FL (21 minutes) ( P = 0.002). Patient satisfaction was lower with US than with FL ( P < 0.001).…”