Splanchnic Nerve Block for Chronic Heart Failure

Fudim, Marat; Boortz-Marx, Richard L.; Garg, Arun; DeVore, Adam D.; Patel, Chetan B.; Rogers, Joseph G.; Coburn, Aubrie; Johnson, I.R.; Paul, Amy; Coyne, Brian J.; Rao, Sunil V.; Gutiérrez, Jorge; Kiefer, Todd L.; Kong, David F.; Green, Cynthia L.; Jones, W. Schuyler; Felker, G. Michael; Hernandez, Adrian F.; Patel, Manesh R.

doi:10.1016/j.jchf.2020.04.010

Cited by 48 publications

(39 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Temporary GSN block has demonstrated acute improvements in PCWP in hospitalized HF and chronic HFrEF. 11,12 The current study establishes that the reduction in PCWP may be sustained via a long-term modality of GSN modulation, and such favourable alterations in haemodynamics are also noted in HFpEF (Figure 1). 13 Despite demonstration of feasibility of surgical GSN ablation, less invasive methods of GSN modulation may provide potential for similar efficacy without accompanying side effects of surgery.…”

supporting

confidence: 64%

The splanchnic reservoir: an oasis for blood volume in heart failure with preserved ejection fraction?

Patel

Shah

2021

European J of Heart Fail

View full text Add to dashboard Cite

supporting

confidence: 64%

The splanchnic reservoir: an oasis for blood volume in heart failure with preserved ejection fraction?

Patel

Shah

2021

European J of Heart Fail

View full text Add to dashboard Cite

“…The safety and efficacy of temporary SNM were investigated in two small proof-of-concept studies in patients with decompensated HF (Splanchnic HF-1 -ClinicalTrials.gov NCT02669407; n = 11), 48,49 and chronic HF (Splanchnic-HF-2 -ClinicalTrials.gov NCT03453151; n = 15). 50 In patients with advanced HFrEF hospitalized for an acute decompensated HF, bilateral temporary SNM with a needle based injection of lidocaine at the GSN (duration of action <90 min) lowered resting right-and left-sided filling pressures and improved cardiac output without procedure-or nerve block-related complications. 48,49 In patients with ambulatory, chronic HF (mostly HFrEF), SNM with ropivacaine (duration of action <24 h) reduced resting pulmonary capillary wedge pressure (PCWP) from 28.3 ± 7.6 to 20.3 ± 9.5 mmHg (P < 0.001) and peak exercise PCWP from 34.8 ± 10.0 to 25.1 ± 10.7 mmHg (P < 0.001).…”

Section: Splanchnic Nerve Modulation For the Management Of Heart Failure: Pilot Study Resultsmentioning

confidence: 99%

Splanchnic nerve modulation in heart failure: mechanistic overview, initial clinical experience, and safety considerations

Fudim

Ponikowski

Burkhoff

et al. 2021

European J of Heart Fail

Self Cite

View full text Add to dashboard Cite

Volume recruitment from the splanchnic compartment is an important physiological response to stressors such as physical activity and blood loss. In the setting of heart failure (HF), excess fluid redistribution from this compartment leads to increased cardiac filling pressures with limitation in exercise capacity. Recent evidence suggests that blocking neural activity of the greater splanchnic nerve (GSN) could have significant benefits in some patients with HF by reducing cardiac filling pressures and improving exercise capacity. However, to date the long-term safety of splanchnic nerve modulation (SNM) in the setting of HF is unknown. SNM is currently used in clinical practice to alleviate some forms of chronic abdominal pain. A systematic review of the series where permanent SNM was used as a treatment for chronic abdominal pain indicates that permanent SNM is well tolerated, with side-effects limited to transient diarrhoea or abdominal colic and transient hypotension. The pathophysiological role of the GSN in volume redistribution, the encouraging findings of acute and chronic pilot SNM studies and the safety profile from permanent SNM for pain provides a strong basis for continued efforts to study this therapeutic target in HF.

show abstract

“…It is suitable for mixed nerves such as the posterior branch of the spinal nerve because of its high lipid solubility and anesthetic e cacy, as well as its strong separation effect on motor nerve block and sensory nerve block. Ropivacaine is also less toxic to the heart, so it is available for local blocks in elderly patients [24,25]. The commonly used concentration of this drug is between 0.5% and 1.0% and the blockade of sensory nerves is about 3-5 hours, so that it is fast and long lasting in local analgesia.…”

Section: Discussionmentioning

confidence: 99%

Study on the Therapeutic Effect of ESPB for Patients Undergoing Percutaneous Vertebroplasty

Peng

Jiang

2022

Preprint

View full text Add to dashboard Cite

Objective To compare the difference oftherapeutic effect between percutaneous vertebroplasty (PVP)alone and PVP + Erector spinal plane block (ESPB) in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods After admission, 100 patients with osteoporotic vertebral compression fracture were randomly divided into PVP group (control group) and PVP+ESPB group (observation group) by lottery with 50 patients in each group.The visual analog pain scores (VAS) and oswestry disability index (ODI) of each group were compared before surgery, 2 hours after surgery and at the time of hospital discharge. The operation time, filling volume of intraoperative bone cement, intraoperative bloodloss, and surgery cost of each group were compared.Theearly postoperative ambulation time and early postoperative defecation (stool) time ofeach group were compared to explore the difference.Results The PVP+ESPB group had better visual analog pain scores (VAS) and oswestry disability index (ODI) at 2 hours after surgery and at the time of hospital discharge, and better early postoperative ambulation timeand early postoperative defecation (stool) timethan the PVP group (p<0.05). There were no differences in the visual analog pain scoresand oswestry disability index before surgery, operative time, filling volume of intraoperative bone cement, intraoperative blood loss, and surgery cost between the two groups, and no complications occurred between the two groups after surgery and at the time of hospital discharge. Conclusion PVP+ESPB for OVCF is associated with lower VAS, more significant pain relief, and lower oswestry disability index in patients after surgery than PVP alone for OVCF, and patients are able to engage in ambulation time earlier. Meanwhile, PVP+ESPB promotes recovery of intestinalfunction and improves patients’ quality of life so as tocontribute toquick recovery.

show abstract

Splanchnic Nerve Block for Chronic Heart Failure

Cited by 48 publications

References 26 publications

The splanchnic reservoir: an oasis for blood volume in heart failure with preserved ejection fraction?

The splanchnic reservoir: an oasis for blood volume in heart failure with preserved ejection fraction?

Splanchnic nerve modulation in heart failure: mechanistic overview, initial clinical experience, and safety considerations

Study on the Therapeutic Effect of ESPB for Patients Undergoing Percutaneous Vertebroplasty

Contact Info

Product

Resources

About