Presented at the 2013 AAPM Annual Meeting « Back

Efficacy of the Anterior Ultrasound-Guided Superior Hypogastric Plexus

Seema Mishra, MD, seemamishra2003@gmail.com¹, Sanjay Thulkar, MD², (1) AIIMS, New Delhi, India, (2) IRCH AIIMS, New Delhi, India

Introduction: Pelvic cancer pain is a chronic pain related to involvement of viscera, neural and pelvic muscular. The study was carried out to evaluate the Efficacy of the Anterior Ultrasound-Guided Superior Hypogastric Plexus Neurolysis in pelvic cancer pain in gynaecological cancer patients. Material and Methods: Study was conducted after approval of our Institutional Ethics Committee. The patients diagnosed with the advanced stage of gynaeoncologic malignancy with the severe pelvic pain were enrolled and divided in 2 groups; Group 1- Patients were given oral morphine while Group II - Patients underwent anterior USG guided superior hypogastric neurolysis. Oral morphine was given as rescue analgesic in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score and adverse effects. Results: There was significant decrease in VAS ( Visual Analogue Scale) score in the both groups but decline in VAS scores from baseline in Group II was statistically significant (p<0.05). The daily morphine consumption in Group II decreased significantly throughout the study. However the number of patients with improved functional capacity was more in Group II, although it was statistically insignificant. It was observed that global satisfaction score was better in the Group II in the initial first (p=0.001) week and one month (p 0.04) compared to the Group I. Conclusions: The anterior USG guided superior hypogastric plexus neurolysis is useful technique in relieving pelvic pain in gynaecological malignancies. However, it requires the expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy guided superior hypogastric block. References: 1) Plancarte R, de Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth 22:562-568, 1997. 2) De Leon-Casasola OA, Kent E, Lema MJ - Neurolytic superior hypogastric 3) S. Mishra, S. Bhatnagar, D. Gupta, S. Thulkar. Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesthesia Intensive care 36(5):732-735, 2008.

Funding: All India Institute of Medical Sciences Research Grant, Delhi, India

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