EVALUATE THE EFFECTS OF CT-GUIDED SPLANCHNIC NERVE NEUROLYSIS IN PAIN CAUSED BY UPPER ABDOMINAL VISCERAL MALIGNANCIES

Tong Ngoc Tien1,, Pham Minh Thong 1, Nguyen Thi Van2, Ngo Le Lam2, Nguyen Quoc Dat2
1 Hanoi Medical University
2 Vietnam National Cancer Hospital

Main Article Content

Abstract

Objective: This study aims to assess the efficacy of CT-guided splanchnic nerve neurolysis in alleviating pain associated with malignancies in the upper abdominal viscera.


Methods: A single-arm investigation involved 20 patients diagnosed with upper abdominal visceral malignancies and experiencing pain with a VAS ≥ 7. All participants underwent CT-guided splanchnic nerve neurolysis utilizing absolute alcohol ablation. Pain intensity was measured using the visual analog scale (VAS) one-day post-procedure, at one week, and at one-month follow-up. The primary endpoint was to evaluate the effectiveness of pain relief based on VAS scores. Incidences of intra- and post-procedural complications were meticulously documented.


Results: The mean age of participants was 60.7±11.1, with 12 men and 8 women included in the study. Assessment of pain relief, as per the Visual Analogue Scale (VAS) one day following the intervention, revealed a 70% efficacy in the group with substantial relief and 30% with moderate relief. The average VAS score exhibited a significant decrease immediately post-intervention (8.7±1.1 vs. 3.4±1.3, p<0.05). The average VAS scores remained relatively stable at 2.6±1.5 and 2.1±1.5 at the one-week and one-month follow-up, respectively. Common complications included orthostatic hypotension (40%), initial pain (30%), acute intoxication (25%), and diarrhea (15%). No instances of severe complications were recorded.


Conclusion: CT-guided splanchnic nerve neurolysis using absolute alcohol is deemed a secure and productive method for promptly mitigating pain and sustaining pain stability for up to one month.

Article Details

References

1. H S, J F, Rl S, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians. 2021;71(3). doi:10.3322/caac.21660
2. Komasawa N, Hato A, Ikegaki J. [Efficacy of CT-guided splanchnic nerve block for persistent pain after fluoroscopyguided nerve block in a patient with advanced pancreatic cancer]. Masui. 2014;63(1):98-100.
3. Coeliac plexus block with alcohol for relief of upper abdominal pain due to cancer. - PMC. Accessed September 15, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491549/
4. Fujita Y. CT-guided neurolytic splanchnic nerve block with alcohol. Pain. 1993;55(3):363-366. doi:10.1016/03043959(93)90012-E
5. Gia KĐ, Duy DL, Thị KM, Văn TN, Quốc TT, Quang TN. Đánh giá hiệu quả giảm đau bằng tiêm cồn tuyệt đối diệt hạch đám rối thân tạng dưới hướng dẫn của cắt lớp vi tính và robot maxio. vjrnm. 2021;(45):24-30. doi:10.55046/ vjrnm.45.66.2021
6. Comlek S. Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis. J Pain Res. 2020;13:2023-2031. doi:10.2147/JPR.S266689
7. Cariati M, Henriquet F, Fiorentini F, et al. [Computerized tomography-guided neurolytic block of the splanchnic nerve]. Radiol Med. 1997;93(6):739-742.
8. Matsumoto T, Yoshimatsu R, Osaki M, et al. Percutaneous splanchnic nerve neurolysis analgesic efficacy and safety for cancer-related pain: a systematic review and meta-analysis. Support Care Cancer. 2023;31(6):324. doi:10.1007/s00520-023-07746-y
9. Jain D, Dutta A, Sood D. Coeliac plexus blockade and neurolysis: An overview. Indian J Anaesth. 2006;50:169-177.
10. Subramaniam S, Rajendran A, Gobinath M, Raghulraj G, Bhaskar M. Effects of the Celiac Plexus Block versus Splanchnic Nerve Block for Upper Abdominal Tumors on Pain Relief and Quality of Life–randomized Comparative Study. International journal of scientific study. 2021;8(12):136-140. 11. Polati E, Luzzani A, Schweiger V, Finco G, Ischia S. The role of neurolytic celiac plexus block in the treatment of pancreatic cancer pain. Transplant Proc. 2008;40(4):1200-1204. doi:10.1016/j.transproceed.2008.03.115.