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Early Ultrasound‐Guided Neurolysis for Pain Management in Gastrointestinal and Pelvic Malignancies: An Observational Study in a Tertiary Care Center of Urban India
Author(s) -
Bhatnagar Sushma,
Khanna Sandeep,
Roshni S.,
Goyal Gaurav N.,
Mishra Seema,
Rana Shiv P. S.,
Thulkar Sanjay
Publication year - 2012
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2011.00467.x
Subject(s) - medicine , neurolysis , cancer pain , surgery , brief pain inventory , anesthesia , cancer , chronic pain , physical therapy
Patients with advanced gastrointestinal and pelvic malignancies commonly present with pain of varying severity. In a majority of these patients, pain can be effectively managed using an integrated systemic pharmacological approach with oral morphine being the cornerstone of treatment. However, with escalating doses, intolerable side effects of oral morphine may lead to patient dissatisfaction. When oral pharmacotherapy fails to adequately address the issue of pain or leads to insufferable side effects, neurolytic blocks of the sympathetic axis are usually used for pain alleviation. As these blocks may reduce oral analgesic requirement, a reevaluation of their timing is merited. This article presents our hospital‐based in‐patient palliative care unit experience with early ultrasonography‐guided neurolysis of celiac plexus, superior hypogastric plexus and ganglion impar. Of the 44 patients we studied, 20 underwent celiac plexus neurolysis, 18 superior hypogastric plexus neurolysis, and 6 ganglion impar neurolysis. Their pain was being managed with oral morphine before neurolysis, but only 11.4% patients required oral morphine for satisfactory pain control, 2 months after neurolysis. The mean Visual Analog Scale score before block placement was 5.64 ± 0.69 and fell to 2.25 ± 1.33 at 2 months post neurolysis ( P < 0.001). We suggest that bedside ultrasonography‐guided sympathetic axis neurolysis may be employed early in patients with incurable abdominal or pelvic cancer. Its use as a first‐line intervention for achieving pain control with minimal complications warrants further consideration and investigation. ▪