Fluoroscopy-Guided Splanchnic Nerve Block for Cancer-Associated Pain

Abstract

Pain associated with abdominal malignancies or metastasis can be very severe and can be intractable and resistant to conventional pharmacologic therapies. Typically, narcotics and non-narcotics are used in combination to alleviate the cancer pain, but these are often unsuccessful.Neurolysis and radio-frequency ablation of the celiac plexus and splanchnic nerves is being used with great success for management of the pain associated with abdominal malignancies with added advantages of improving quality of life, pain relief and decreased narcotic consumption. The tumor or associated lymphadenopathy may result in distortion of the celiac plexus anatomy, thus making it hard to reach the celiac plexus. In such cases, splanchnic nerve block can be employed with relative ease as compared to celiac plexus block.Given the nature of the debilitating pain associated with these conditions and inadequate pain relief with narcotics, these blocks are a boon in disguise to such patients with altered anatomy. Post administration of the splanchnic block, the functioning and quality of life of patients with abdominal malignancies improve. Hence, these blocks can be used to decrease the morbidity associated with abdominal malignancies.

Clinical Significance of Mean Platelet Volume Combined with Neutrophil–Lymphocyte Ratio in Predicting the Therapeutic Effect of Splanchnic Neurolysis

“…The blockade of these nerves is termed as splanchnic nerve block. 20 For patients with abdominal pain caused by malignant tumors, splanchnic neurolysis has been used to deal with pain mainly located in epigastrium, periumbilical, and other areas. However, it has not been widely applied in the field of cancer pain treatment in many developing countries.…”

“… 10 In 1914, Kappis first proposed celiac plexus and splanchnic nerve block and it became an alternative strategy for pain treatment. 11 Splanchnic neurolysis has the advantages of fewer traumas, higher efficiency, and fewer side effects, which can effectively help patients relieve pain, improve function, and reduce opioid tolerance and dependence. 10 However, in clinical application, neurolysis does not achieve satisfactory analgesic effect in all cases.…”

Two Cases of Splanchnic Nerve Block With Epidural Anesthesia in Patients Unable to Maintain Prone Position Due to Pancreatic Pain

“…We performed splanchnic nerve block under CT guidance for both patients, but the procedure can also be performed under X-ray fluoroscopy guidance, which also requires the prone position. 6 For both techniques, it is necessary to maintain the prone position for a substantial amount of time during the procedure. However, both of our patients found it difficult to maintain the prone position owing to their pain.…”

Comparison of Dexamethasone Versus Methylprednisolone With Bupivacaine in Transversus Abdominis Plane Block for Attenuation of Chronic Postoperative Abdominal Pain

“…The other adverse effects include tolerance, hyperalgesia, addiction, hypothalamic-pituitary-adrenal dysregulation, and hypogonadism [10]. Splanchnic nerve block, neuro-modulation, coeliac plexus block and splanchnic radiofrequency ablation have improved visceral pain [20,21]. Limited options are left for patients and providers when these pain management methods are ineffective.…”