Plancarte R, de Leon-Casasola O A, El-Helaly M, Allende S, Lema M J
Department of Anesthesiology and Pain Medicine, National Institute of Cancer, Mexico.
Reg Anesth. 1997 Nov-Dec;22(6):562-8.
Neurolytic superior hypogastric plexus block has been shown to be safe and effective in selected cancer patients. A large cohort of patients was studied to evaluate the continued efficacy and safety of this block in cancer patients with advanced disease.
A total of 227 pelvic pain patients with gynecological, colorectal, or genitourinary cancer who experienced poor pain control due to either progression of disease or to untoward side effects were enrolled in this study during a 3-year period. All pain patients receiving oral opioids were eligible to participate. A bilateral percutaneous neurolytic superior hypogastric plexus block with 10% phenol was performed 1 day after a successful diagnostic block with 0.25% bupivacaine.
All patients reported a visual analog scale (VAS) pain score of 7-10/10 before the block. A positive response to a diagnostic block was obtained in 159 patients (79%). Overall, 115 patients of the 159 patients who responded to a diagnostic block (72%, 95% confidence interval of 65-79%) had satisfactory pain relief (VAS < 4/10), 99 (62%) after one block, and 16 (10%) after a second block. The remaining 44 patients (28%) had moderate pain control (VAS 4-7/10) after two blocks and received oral pharmacological therapy and epidural analgesic therapy with good results. Both groups experienced significant reductions in oral opioid therapy after the neurolytic blocks. No additional blocks were required by patients who had a good response during a follow-up period of 3 months. No complications related to the block were detected.
Neurolytic superior hypogastric plexus block provided both effective pain relief and a significant reduction in opioid usage (43%) in 72% of the patients who received a neurolytic block. Overall, this represents 51% of the patients enrolled in the study. Poor results should be expected in patients with extensive retroperitoneal disease overlying the plexus because of inadequate spread of the neurolytic agent.
已证明神经溶解型上腹下丛阻滞在特定癌症患者中是安全有效的。本研究纳入了一大群患者，以评估该阻滞在晚期癌症患者中的持续有效性和安全性。
在3年期间，共有227例因疾病进展或不良副作用而疼痛控制不佳的妇科、结直肠癌或泌尿生殖系统癌症盆腔疼痛患者纳入本研究。所有接受口服阿片类药物的疼痛患者均有资格参与。在成功进行0.25%布比卡因诊断性阻滞后1天，进行双侧经皮10%酚神经溶解型上腹下丛阻滞。
所有患者在阻滞前视觉模拟量表（VAS）疼痛评分为7 - 10/10。159例患者（79%）诊断性阻滞反应阳性。总体而言，159例对诊断性阻滞有反应的患者中，115例（72%，95%置信区间为65 - 79%）疼痛缓解满意（VAS < 4/10），一次阻滞后99例（62%），二次阻滞后16例（10%）。其余44例患者（28%）二次阻滞后疼痛得到中度控制（VAS 4 - 7/10），并接受口服药物治疗和硬膜外镇痛治疗，效果良好。两组患者在神经溶解型阻滞后口服阿片类药物治疗均显著减少。在3个月的随访期内反应良好的患者无需额外阻滞。未检测到与阻滞相关的并发症。
神经溶解型上腹下丛阻滞在72%接受神经溶解型阻滞的患者中提供了有效的疼痛缓解，并显著减少了阿片类药物的使用（43%）。总体而言，这占研究纳入患者的51%。由于神经溶解剂扩散不充分，预计在上腹下丛上方有广泛腹膜后疾病的患者中效果不佳。
