E-Da Hospital, I-Shou University, Neurosurgery Kaohsiung, Taiwan.
E-Da Cancer Hospital, Kaohsiung, Taiwan.
Pain Physician. 2018 Jul;21(4):E341-E345.
A superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5.
We report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle.
A technical note describing interventional procedures.
The neurosurgery department of a cancer hospital.
The patient was placed in the prone position with a pillow beneath the iliac crest to facilitate opening of the intervertebral disc. The entry point for the needle was 7-8 cm to the left of the midline of the L45 level. The spinal needle was slightly advanced caudally toward the L5-S1 disc and at a 40° angle from the vertical plane. Using lateral fluoroscopic control, the needle was advanced beneath the inferior aspect of the facet joint. After entering the disc, the needle was then advanced until it passed the anterior annulus fibrosus of the L5S1 disc. After verifying adequate position using contrast, 3 mL of 75% ethanol was injected for neurolysis.
During the follow-up, the patient reported reduction of pain in the lower abdomen and quality of life was significantly improved.
Sample size; no placebo control.
Although different approaches exist, we prefer the posterolateral transdiscal approach for superior hypogastric plexus block and neurolysis using a single needle. This technique is a valuable alternative.
Superior hypogastric plexus neurolysis, transdiscal approach, cancer pain.
由于髂嵴和 L5 横突的骨性结构，很难进行上腹下丛阻滞，并且会受到阻碍。
我们报告了一种使用单针经荧光引导的后外侧经椎间盘技术进行上腹下丛神经松解术。
描述介入程序的技术说明。
癌症医院的神经外科部门。
患者取俯卧位，在髂嵴下方垫一个枕头，以方便椎间盘张开。进针点位于 L45 水平中线左侧 7-8cm 处。将脊柱针稍向尾侧推进，朝向 L5-S1 椎间盘，并与垂直平面成 40°角。使用侧位荧光透视控制，将针推进到关节突关节的下侧。进入椎间盘后，将针推进，直到穿过 L5S1 椎间盘的前纤维环。使用对比剂确认适当位置后，注入 3ml 75%乙醇进行神经松解。
在随访期间，患者报告下腹疼痛减轻，生活质量明显改善。
样本量小；无安慰剂对照。
尽管存在不同的方法，但我们更喜欢使用单针经后外侧经椎间盘入路进行上腹下丛阻滞和神经松解。这种技术是一种有价值的替代方法。
上腹下丛神经松解、经椎间盘入路、癌症疼痛。
