Jyothi B, Mitragotri Milon V, Ladhad Dharmesh A, Kurdi Madhuri, Kurugodiyavar Mahesh D, Jadhav Sanjivani
Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India.
Department of Community Medicine, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India.
Saudi J Anaesth. 2024 Jul-Sep;18(3):371-375. doi: 10.4103/sja.sja_86_24. Epub 2024 Jun 4.
Splanchnic nerve block (SPN) with local anesthetic and steroid is used to relieve the pain of chronic pancreatitis. However, it does not provide long-lasting relief. We hypothesize that the use of 70% alcohol will give adequate analgesia for more than months.
The primary objective was to find out the analgesic efficacy of the use of 70% alcohol with SPN. Secondary objectives included the incidence of side effects, analgesic consumption postintervention, quality of life (QOL) assessed via a self-reported quality of life scale, and repeat block during the 1-year follow-up period.
Retrospective analysis of all patients with chronic pancreatitis who received bilateral SPN over the last 4 years.
SPN was performed using the posterior retrocrural approach with the patient in the prone position as described in the literature using a 23 G × 90 mm spinal needle bilaterally at the level of T12 using C-arm/fluoroscopy guidance. Data were collected from the procedure book of the pain clinic and medical records.
Quantitative data for change in pre- to post-block VAS score was collected using the non-parametric Wilcoxon signed ranks test.
The baseline VAS, post-procedure VAS, and VAS at 3 months follow-up was 7.69 ± 1.3,2.44 ± 0.96 and 1.56 ± 1.15. A pairwise comparison of VAS performed between baseline and immediate post-procedure, baseline, and VAS at 3 months was found to be highly significant.
Fluoroscopy-guided neurolytic SPN with 70% alcohol gives significant pain relief for more than 3 months. It also leads to improvement in 3 months QOL.
使用局部麻醉剂和类固醇进行内脏神经阻滞（SPN）可缓解慢性胰腺炎的疼痛。然而，它并不能提供持久的缓解效果。我们假设使用70%酒精将能提供数月以上的充分镇痛效果。
主要目标是找出70%酒精联合SPN的镇痛效果。次要目标包括副作用发生率、干预后镇痛药物消耗量、通过自我报告的生活质量量表评估的生活质量（QOL）以及1年随访期内的重复阻滞情况。
对过去4年中接受双侧SPN的所有慢性胰腺炎患者进行回顾性分析。
采用文献中描述的后纵隔后入路，患者俯卧位，使用23G×90mm脊髓穿刺针在C形臂/荧光透视引导下于T12水平双侧进行SPN。数据从疼痛诊所的手术记录册和病历中收集。
使用非参数Wilcoxon符号秩检验收集阻滞前后视觉模拟评分（VAS）变化的定量数据。
基线VAS、术后VAS以及3个月随访时的VAS分别为7.69±1.3、2.44±0.96和1.56±1.15。基线与术后即刻、基线与3个月时VAS的两两比较差异高度显著。
荧光透视引导下用70%酒精进行神经溶解型SPN可在3个月以上显著缓解疼痛。它还能改善3个月时的生活质量。
