Hou Saiyun, Novy Diane, Felice Francis, Koyyalagunta Dhanalakshmi
Department of Pain Medicine, MD Anderson Cancer Center, Houston, Texas.
Department of Anesthesiology, University of Texas Health Science Center, Houston, TX 77030.
Pain Med. 2020 Jun 1;21(6):1255-1262. doi: 10.1093/pm/pnz151.
Cancer-related abdominal and pelvic pain syndromes can be debilitating and difficult to treat. The objective of this study was to evaluate the efficacy of superior hypogastric plexus blockade or neurolysis (SHPN) for the treatment of cancer-related pelvic pain.
Retrospective study.
MD Anderson Cancer Center, Houston, Texas.
We enrolled 46 patients with cancer-related pelvic pain who underwent SHPN. A numeric rating scale (NRS) was used for pain intensity, and symptom burden was evaluated using the Edmonton Symptom Assessment System at baseline, visit 1 (within one month), and visit 2 (within one to six months).
Forty-six patients who received SHPN showed a significant reduction in pain score from 6.9 to 5.6 at visit 1 (P = 0.01). Thirty of the 46 patients continued to complete visit 2 follow-up, and the NRS score was consistently lower at 4.5 at visit 2 (P < 0.0001), with anxiety and appetite improved significantly. There was no significant change in the morphine equivalent dose at visits 1 and 2. The efficacy of the block was not influenced by patients' age, gender, type of cancer, cancer stage, regimen of chemotherapy and/or radiation therapy, diagnostic block, approach or laterality of procedure, or type or amount of neurolytic agent. Nonsmokers with high baseline pain scores were more likely to have improved treatment outcomes from SHPN at short-term follow-up. Adverse effects with SHPN were mild and well tolerated.
SHPN was an effective and relatively safe procedure for pain associated with pelvic malignancies. There is a need for larger prospective trials.
癌症相关的腹部和盆腔疼痛综合征可能使人虚弱且难以治疗。本研究的目的是评估上腹下丛阻滞或神经松解术（SHPN）治疗癌症相关盆腔疼痛的疗效。
回顾性研究。
德克萨斯州休斯顿市的MD安德森癌症中心。
我们纳入了46例接受SHPN治疗的癌症相关盆腔疼痛患者。使用数字评分量表（NRS）评估疼痛强度，并在基线、第1次随访（1个月内）和第2次随访（1至6个月内）时使用埃德蒙顿症状评估系统评估症状负担。
46例接受SHPN治疗的患者在第1次随访时疼痛评分从6.9显著降至5.6（P = 0.01）。46例患者中有30例继续完成第2次随访，第2次随访时NRS评分持续较低，为4.5（P < 0.0001），焦虑和食欲显著改善。第1次和第2次随访时吗啡等效剂量无显著变化。阻滞的疗效不受患者年龄、性别、癌症类型、癌症分期、化疗和/或放疗方案、诊断性阻滞、手术入路或侧别，或神经松解剂的类型或用量影响。基线疼痛评分高的非吸烟者在短期随访中更有可能从SHPN治疗中获得更好的治疗效果。SHPN的不良反应轻微且耐受性良好。
SHPN是治疗盆腔恶性肿瘤相关疼痛的一种有效且相对安全的方法。需要进行更大规模的前瞻性试验。
