Clinic of Pain and Palliative Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico.
Reg Anesth Pain Med. 2010 Nov-Dec;35(6):500-6. doi: 10.1097/AAP.0b013e3181fa6b42.
The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief.
The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction.
Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed.
Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications.
腹腔神经丛阻滞术被广泛用于缓解上腹部恶性肿瘤引起的难治性疼痛。然而，由于恶性肿瘤导致的结构解剖学扭曲等诸多原因，其效果并不一致。内脏神经阻滞（SNB）似乎是上腹部疼痛缓解中替代腹腔神经丛阻滞术的一种有效方法。
2004 年 1 月至 2007 年 6 月，墨西哥城国家癌症研究所采用 CT 引导下经皮后椎间盘内脏神经阻滞术对 109 例无法切除的上腹部或下食管肿瘤患者的疼痛进行了管理。该研究评估了内脏神经阻滞术缓解疼痛的效果，以及其不良反应/并发症和患者满意度。
内脏神经阻滞术缓解疼痛的效果显著，表现为视觉模拟评分和阿片类药物消耗量明显下降，术前平均值分别从 6.1±2.4 和 102.4mg/d 吗啡降至首次术后就诊时的 2.7±2.4 和 53.3mg/d，这些结果在 1 年的随访期间或直至死亡时仍然存在。轻微的不良反应（中度腹泻和轻度低血压）较为常见（分别为 n=64 和 n=47），1 例患者出现短暂性截瘫（n=1）发生严重并发症。无与手术相关的死亡。
经皮后椎间盘内脏神经阻滞术是一种提供镇痛并减轻上腹部恶性肿瘤患者因吗啡消耗量减少而导致的药物不良反应的技术。在有经验的团队中，其镇痛效果可靠，严重并发症发生率低。
