Yanaizumi Ryota, Nagamine Yusuke, Harada Shinsuke, Kuramochi Tomoko, Ota Shuhei, Abe Yoichiro, Nakagawa Masayuki, Kamijima Kenya, Hayashi Maya, Tazawa Toshiharu, Ogawa Kenichi, Goto Takahisa
Department of Anesthesiology, Yokohama City University Medical Center, Yokohama, Japan.
Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
Pain Ther. 2022 Dec;11(4):1359-1372. doi: 10.1007/s40122-022-00432-7. Epub 2022 Sep 28.
Celiac plexus block is effective for treating intractable cancer pain and has been the focus of many studies. Several guiding techniques such as fluoroscopy, computed tomography, and endoscopy have been devised, and the target of the block has varied in previous studies as both the celiac plexus and splanchnic nerve, which is the main origin of the celiac plexus, have been targeted. At our affiliated institution, fluoroscopy-guided splanchnic nerve block with a single needle via transintervertebral disc approach is the first choice. However, there have been few reports on the use of this technique. This study investigated the efficacy and safety of this technique.
This multicenter retrospective observational study reviewed the medical records of patients who underwent neurolytic splanchnic nerve block (NSNB) via transintervertebral disc approach for intractable cancer pain at five tertiary hospitals in Japan from April 2005 to October 2020. The primary outcome was the clinical success ratio of NSNB, and the secondary outcome was the incidence ratio of NSNB-related adverse events.
In total, 103 patients were included in the analysis. Of these, 77 patients met the definition of clinical success, with a ratio of 74.8%. The incidence ratio of NSNB-related adverse events was 40.8% (hypotension, 21.4%; alcohol intoxication, 13.6%; diarrhea, 11.7%; and vascular puncture, 3.9%; duplicates were present). All adverse events improved with observation and symptomatic treatment only. No patient had infection or serious adverse events such as organ or nerve damage.
The clinical success ratio of this technique was 74.8%. Although the incidence of adverse events was 40.8%, all events were mild and no serious adverse events were observed. The findings demonstrate the efficacy and safety of our NSNB in patients with intractable cancer pain.
腹腔神经丛阻滞对治疗顽固性癌痛有效，一直是众多研究的焦点。已设计出几种引导技术，如荧光透视、计算机断层扫描和内窥镜检查，并且在先前的研究中，阻滞的靶点有所不同，因为腹腔神经丛及其主要起源内脏神经均已作为靶点。在我们的附属医院，经椎间盘入路单针荧光透视引导下内脏神经阻滞是首选方法。然而，关于该技术应用的报道较少。本研究调查了该技术的有效性和安全性。
这项多中心回顾性观察研究回顾了2005年4月至2020年10月期间在日本五家三级医院接受经椎间盘入路用于顽固性癌痛的神经溶解内脏神经阻滞（NSNB）患者的病历。主要结局是NSNB的临床成功率，次要结局是NSNB相关不良事件的发生率。
总共103例患者纳入分析。其中，77例患者符合临床成功的定义，比例为74.8%。NSNB相关不良事件的发生率为40.8%（低血压，21.4%；酒精中毒，13.6%；腹泻，11.7%；血管穿刺，3.9%；存在重复情况）。所有不良事件仅通过观察和对症治疗即可改善。没有患者发生感染或器官或神经损伤等严重不良事件。
该技术的临床成功率为74.8%。虽然不良事件的发生率为40.8%，但所有事件均为轻度，未观察到严重不良事件。研究结果证明了我们的NSNB在顽固性癌痛患者中的有效性和安全性。
