Pain Res Manag. 2013 Sep-Oct;18(5):249-52. doi: 10.1155/2013/196561. Epub 2013 May 28.
Various interventions, including the superior hypogastric plexus block and ganglion impar block, are commonly used for the treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block (performed using a trans-sacral approach under fluoroscopy and using a local anesthetics⁄steroid combination) for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described in 2007. Neurolysis of the inferior hypogastric plexus may be useful for the treatment of pelvic and perineal pain caused by cancer.
To assess the feasibility, safety and efficacy of the newly introduced inferior hypogastric plexus block, performed using a trans-sacral approach, for the relief of cancer-related pelvic and perineal pain.
A total of 20 patients with cancer pain in the pelvis and⁄or perineum were injected with 6 mL to 8 mL of 10% phenol bilaterally by passing a spinal needle through the sacral foramen to perform the inferior hypogastric block. Pain intensity (measured using a visual analogue scale), sleep score, activity score, psychological score and oral morphine consumption pre- and postprocedure were measured.
Two of the 20 patients died during the follow-up period and were, therefore, excluded from the study. All patients presented with cancer-related pelvic, perineal or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.22±1.31 preprocedurally to 4.06±1.73 one week postprocedurally (P<0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 106.67±32.90 mg to 61.67±40.48 mg after one week (P<0.05). No complications or serious side effects were encountered during or after the block.
The approach provides a good alternative technique for the treatment of low pelvic and perineal cancer-related pain. Additional studies are required for evaluation and refinement of the technique using other radiological techniques.
各种干预措施，包括上腹下丛阻滞和腹下神经节阻滞，常用于治疗癌症引起的盆腔或会阴疼痛。2007 年首次描述了经骶骨入路在下腹下丛阻滞（在透视下使用局部麻醉剂/类固醇混合物进行）用于诊断和治疗涉及下盆腔内脏的慢性疼痛的情况。下腹下丛神经松解术可能对治疗癌症引起的盆腔和会阴疼痛有效。
评估新引入的经骶骨入路下腹下丛阻滞缓解癌症相关盆腔和会阴疼痛的可行性、安全性和疗效。
对 20 例骨盆和/或会阴癌痛患者进行双侧骶骨孔穿刺，每侧注射 6-8ml 10%苯酚，行下腹下阻滞。术前和术后分别测量疼痛强度（采用视觉模拟评分法）、睡眠评分、活动评分、心理评分和口服吗啡消耗量。
20 例患者中有 2 例在随访期间死亡，因此被排除在研究之外。所有患者均表现为与癌症相关的骨盆、会阴或骨盆会阴疼痛。疼痛评分从术前的 7.22±1.31 降至术后一周的 4.06±1.73（P<0.05）。此外，术后一周吗啡（通过 30mg 缓释吗啡片给予）的平均消耗量从 106.67±32.90mg 降至 61.67±40.48mg（P<0.05）。在阻滞过程中和之后没有遇到并发症或严重的副作用。
该方法为治疗低盆腔和会阴癌相关疼痛提供了一种良好的替代技术。需要进一步的研究来评估和改进该技术，使用其他放射技术。
