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2003, Number 3

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Cir Cir 2003; 71 (3)

Transdiscal percutaneous approach of splanchnic nerves

Plancarte-Sánchez R, Máyer-Rivera F, del Rocío Guillén NM, Guajardo-Rosas J , Acosta-Quiroz CO

Language: Spanish
References: 55
Page: 192-203
PDF size: 169.81 Kb.


ABSTRACT

Neurolytic celiac plexus block is an established, well-developed procedure and the most accepted and applied in visceral pain; recognized by the WHO and the IASP, it is very good in palliative management of cancer pain in visceral of superior hemiabdomen. However, conventional techniques in celiac plexus have not been successful in patients with organomegaly and/or anatomic abnormalities, except when splachnic nerve neurolitic blockade is used. On the other hand, conventional techniques in splachnic nerves are highly associated with complications such as paraplegia, neumothorax and liver or renal punction. For these reasons an alternative option has ben designed, termed transdiscal percutaneous approach of splachnic nerves under tomographic control; this technique affords the option of improving accuracy and performance with minimum risks, particularly lung puncture and its consequences. Under this technique, 64 superior hemi-abdomen cancer patients initiated such a study (four without morphine treatment quit the study), 55% females and 45% males, visceral pain syndrome 65%, and mixed, 35%. Side effects were dyspnea 5%, hypotension 26.7%, nausea 31.7%, diarrhea 83.3% in which diarrhea means increased peristalsis showing adequate sympathetic inhibition via splachnic nerves), vomiting 28.3%, punction-site pain 46.7%, aorta punction 6.7%, anal pleural punction 5%. All these incidents were dealt with by conservative treatment. Student t showed that pain intensity in all measurements after procedure was different in comparison to basal pain intensity prior to procedure (p < 0.05), emphasizing that at the 12th, 18th and 24th months, there was noticeable reduction in participants number with eight, five and four participants, respectively. Morphine intake at week 1, and 1, 2, 3, 6 and 12 months after procedure was different from basal intake prior to procedure (p < 0.05) with same noticeable reduction in participant numbers at last stages. Butilhioscine intake at week 1, 1, 2, 3 and 6 months after procedure was different from basal intake prior to procedure (p < 0.05). NSAIDs consumption was likely during 2 months after procedure (p<0.05). Linear regression showed that butilhioscine and morphine explained low percentage of pain intensity variance, controlling statistically that effect over pain. There were no differences in pain pathophysiology with regard to cancer type. Transdiscal percutaneous approach of splachnic nerves guided by CAT is an alternative with minimal risks, as with lung punction, confirming that inhibiting splachnic nerves has advantages in pain release, reducing and/or eliminating morphine consumption.


REFERENCES

  1. Kappis M. Sensibilitat and lokale anesthetic imchirurgischen gebeit der bauchkokle mit besonderer berucksichtigung der splanchnicusanashtesie. Beitr Klin Chir 1919;115:161-175.

  2. Plancarte R, Velásquez R, Patt RB. Neurolityc blocks of the sympathetic axis. In: Pa RB editor, Cancer. Pain Philadelphia, PA, USA: J.E. Lippincott, 1993.pp.377-425.

  3. Haaga JR, Kori H, Eastwood DW, Borkowski GP. Improved technique for CT-guided celiac ganglia block. Am J Radiol 1984;142:1201-1204.

  4. A prospective randomized comparison of endoscopic ultrasound and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 1999;94:900-905.

  5. Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus injection for abdominal pain due to chronic pancreatitis. Gastroint Endoscop 1996;44:656-662.

  6. Fields HL, Core curriculum for professional education in pain, nerve blocks. Seattle. WA, USA Iasp Press; 1995.pp.59-62.

  7. Moore DC. Celiac (splanchnic) plexus block with alcohol for cancer pain of the upper intra-abdominal viscera. In: Bonica JJ, Ventafridda V, editors. Advances in pain research and therapy. Vol. 2. New York: Raven Press; 1979.pp.357-371.

  8. Ward EM, Rorie DK, Nauss LA, Bahn RC. The celiac ganglia in man: normal anatomic variations. Anesth Analg 1979;357-371.

  9. Moore DC, Bush WH, Burnett LL. Celiac plexus block: a roentgenographic: anatomic study of technique and spread of solution in patients and corpses. Anesth Analg 1981;60:369-379.

  10. Browns DJ. Bulley CK, Quiel EL. Neurolityc celiac plexus block for pancreatic cancer pain. Anes Analg 1987;66:869-873

  11. Boas RA. Sympathetic blocks in clinical practice. Int Anesthesiol Clin 1978;16:149-162.

  12. Moore DC, Bush WH, Burnett LL. An improved technique for celiac plexus block may be more theoretical than real. Anesthesiology 1982;57:347-349.

  13. Brown DL, Moore DC. The use of neurolytic celiac plexus block for pancreatic cancer: anatomy and technique. J Pain Symptom Manage 1988;3:206-209.

  14. Ina H, Kitoh T, Kobayashi M, Imai S, Ofusa Y, Goto H. New technique for the neurolytic celiac plexus block: the transintervertebral disc approach. Anesthesiology 1996;85:212-217.

  15. Jain S, Chiang J, Vanderslice T. Is diagnostic block necessary prior to neurolytic celiac plexus block? Anesthesiology 1991;75:A749.

  16. Fuijta Y. CT-guided neurolytic splanchnic nerve block with alcohol. Pain 1993;55:363-366.

  17. Ischia S, Ischia A, Polati E, Finco G. Three posterior percutaneous celiac plexus block techniques. Anesthesiology 1992;76:534-540.

  18. Fugére F, Lewis G. Celiac plexus block for chronic pain syndromes. Can J Anaesth 1993;40:954-963.

  19. Ischia S. Luzzani A, Ischia A, Faggion S. A new approach to the celiac plexus: the transaortic technique. Pain 1983;16:333-341.

  20. Lieberman RP, Waldman SD. Celiac plexus neurolysis with the modified trans aortic approach. Radiology 1990;175:274-280.

  21. Hilgier M, Rykowski JJ. One needle transcrural celiac plexus block. Reg Anesth 1994;19:277-283.

  22. Hanemeier V. Neurolytic celiac plexus block for cancer-related upper abdominal pain using unilateral puncture technique and lateral position. Pain 1987;4(Suppl.):S135.

  23. Lee MJ, Mueller PR, van Sonnenberg E, Dawson SL, D’Agostino H, Saini S, Cats AM. CT-guided celiac ganglion block with alcohol. AJR Am J Roentgenol 1993;161:633-636.

  24. Vijayaram S, Chandrashekar NS, Ramamani PV, Saraswthi Devi P, Sudharshan B, Rani U, Pattabhiraman V, Hedge P, Gowda KG, Anantha N. CT-guided celiac neurolysis for upper abdominal cancer. Pain Clin 1992;5:165-173.

  25. Buy JN, Moss AA, Singler RC. CT guided celiac plexus block and splanchnic nerve neurolysis. J Comput Assist Tomogr 1982;6:315-310.

  26. Worsey J, Ferson PF, Keenan RJ, Julian TB, Landreneau RJ. Thoracoscopic pancreatic denervation for pain control in irresectable pancreatic cancer. Br J Surg 1993 ;80:1051-1052.

  27. Humbles FH, Mahaffey JE. Teflon epidural catheter placement for intermittent celiac plexus blockade and celiac plexus neurolytic blockade. Reg Anaesth 1990;15:103-108.

  28. Kobayashi M, Ina H, Imai S, Oyama Z, Otagiri T. Under CT guided celiac plexus block: trans-intervertebral disc approach. Reg Anesth 1992;17:122.

  29. Thompson GE, Moore DC, Bridenbaugh LD, Artin RY. Abdominal pain and alcohol celiac plexus nerve block. Anesth Analg 1977;56:1-5.

  30. Parkinson SK, Mueller JB, Little WL. A new and simple technique for splanchnic nerve block using a paramedian approach and 3 1/2 inch needles. Reg Anesth 1989;14(Suppl):41.

  31. Galizia EJ, Lahiri SK. Paraplegia following celiac plexus block with phenol. Br J Anaesth 1974 ;46:539-540.

  32. Cherny DA, Lambery J. Paraplegia following celiac plexus block. Anesth Intens Care 1984;12:59-61.

  33. Fujita Y, Takaori M. Pleural effusion after CT- guided alcohol celiac plexus block. Anesth Analg 1987;66:911-912.

  34. Woodham MJ, Hanna MH. Paraplegia following celiac plexus block. Anesthesia 1989;44:487-489.

  35. Bowen Wright RM. Precautions against injection into the spinal artery during celiac plexus block. Anaesthesia 1990;45:247-248.

  36. Mercadante S. Octreotide in the treatment of diarrhea induced by celiac plexus block. Pain 1995;61:345-346.

  37. Kaplan R, Schiff-Keren B, Alt E. Aortic dissection as a complication of celiac plexus block. Anesthesiology 1995;83:632-634.

  38. Chan VWC. Chronic diarrhea: an uncommon side effect of celiac plexus block. Anesth Analg 1996;82:205-207.

  39. Iftikahar S, Loftus EV Jr. Gastroparesis after celiac plexus block. Am J Gastroenterol 1998;93:2223-2225.

  40. Lebovits AH, Lefkowitz M. Pain management of pancreatic carcinoma: a review. Pain 1989;36:1-11.

  41. Sharfman WH, Walsh TD. Has the analgesic efficacy of neurolityc celiac plexus block been demonstrated in pancreatic cancer pain? Pain 1990;41:267-271.

  42. Eisenberg E, Carr B, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 1995;80:290-295.

  43. Brown DL, Bulley CK, Quiel EC. Neurolytic celiac plexus block for pancreatic cancer pain. Anesth Analg 1987;66:869-874.

  44. Hanna M, Peat SJ, Woodham MI, Latham J, Gouliaris A, Di Vadi P. The use of celiac plexus blockade in patients with chronic pain. Palliat Med 1989;5:11-16.

  45. Mercadante S. Celiac plexus block versus analgesics in pancreatic cancer pain. Pain 1993;52:187-192.

  46. Kawamata M, Ishitani K, Ishikawa K, Sasaki H, Ota K, Omote K, Namiki A. Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain. Pain 1996;64:597-602.

  47. Owitz S, Koppold S. Celiac plexus block: An over-view. Mt Sinai J Med 1983;50:486-490.

  48. Hastings RH, McKay WR. Treatment of benign chronic abdominal pain with neurolytic celiac plexus block. Anesthesiology 1991;75: 156-158.

  49. Bell S, Cole R, Robert-Thompson IC. Celiac plexus block for control of pain in chronic pancreatitis. Br J Med 1980;281:1604.

  50. Leung JWC, Bowenright M, Aveling W, Shorvon PH, Cotton PB. Celiac plexus block for pain in pancreatic cancer and chronic pancreatitis. Br J Surg 1983;70:730-732.

  51. Myhre J, Hilsted J, Tronier E, Philipsen E, Staffeldt H, Hegedus V, Worming H. Monitoring of celiac plexus block in chronic pancreatitis. Pain 1989;38:269-274.

  52. Mercadante S, Nicosia F. Celiac plexus block: a reappraisal. Region Anesth Pain Med 1998;1:37-48.

  53. Plancarte R, de León Casasola OA, Allende S, Lema MJ. Efectividad clínica de dos diferentes abordajes del bloqueo neurolítico del plexo hipogástrico superior y pacientes con dolor pélvico asociado a actividad retroperitoneal. Region Anesth 1995;20:90.

  54. Flanagan MN, Chung BU. Roentgenographic changes in 188 patients 10-20 years after discography and chemonucleolysis. Spine 1986;11: 444-448.

  55. Johnson RG. Does discography injure normal discs? An analysis of repeat discograms. Spine 1989;14:424-426.




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