Korean J Pain.  2022 Apr;35(2):202-208. 10.3344/kjp.2022.35.2.202.

Splanchnic nerve neurolysis via the transdiscal approach under fluoroscopic guidance: a retrospective study

• Cai Z
• Zhou X
• Wang M
• Kang J
• Zhang M
• Zhou H

• KMID: 2527771
• DOI: http://doi.org/10.3344/kjp.2022.35.2.202

Abstract

Background
Neurolytic celiac plexus block (NCPB) is a typical treatment for severe epigastric cancer pain, but the therapeutic effect is often affected by the variation of local anatomical structures induced by the tumor. Greater and lesser splanchnic nerve neurolysis (SNN) had similar effects to the NCPB, and was recently performed with a paravertebral approach under the image guidance, or with the transdiscal approach under the guidance of computed tomography. This study observed the feasibility and safety of SNN via a transdiscal approach under fluoroscopic guidance.
Methods
The follow-up records of 34 patients with epigastric cancer pain who underwent the splanchnic nerve block via the T11-12 transdiscal approach under fluoroscopic guidance were investigated retrospectively. The numerical rating scale (NRS), the patient satisfaction scale (PSS) and quality of life (QOL) of the patient, the dose of morphine consumed, and the occurrence and severity of adverse events were recorded preoperatively and 1 day, 1 week, 1 month, and 2 months after surgery.
Results
Compared with the preoperative scores, the NRS scores and daily morphine consumption decreased and the QOL and PSS scores increased at each postoperative time point (P < 0.001). No patients experienced serious complications.
Conclusions
SNN via the transdiscal approach under flouroscopic guidance was an effective, safe, and easy operation for epigastric cancer pain, with fewer complications.

Keyword

Abdominal Pain; Alcohols; Autonomic Nerve Block; Cancer Pain; Celiac Plexus; Neoplasms; Nerve Block; Neurolysis; Splanchnic Nerves

Figure

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  Fig. 1 The location of puncture site. (A) The inferior and superior endplate of the T11-12 intervertebral disc kept in a line (red line) in the anteroposterior view. The 3 black lines were Kirschner wires for preliminary positioning assistance. (B) The X-ray tube ball was then rotated to an oblique position ipsilateral, made the tip of the superiorarticular process of T12 point to the midpoint of the T11 vertebral body in the oblique view. The intersection of the 2 red lines was the puncture point on the skin.

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  Fig. 2 Ideal position of the needle. (A) Anteroposterior view, the tip of the needle arrived at the midline, which was bilateral vertebral arch inner range. (B) Lateral view, with the needle tip at the anterior border of the vertebral body.

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  Fig. 3 Ideal spread of the contrast agent. (A) Anteroposterior view, the ideal spread would be seen as a “honeycomb” covering the bilateral vertebral body. (B) Lateral view, contrast agent was confined to the prevertebral tissue plane covering the bilateral T11-12 vertebral body.

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