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Management of Chronic Upper Abdominal Pain in Cancer: Transdiscal Blockade of the Splanchnic Nerves
  1. Ricardo Plancarte, MD, FIPP*,
  2. Jorge Guajardo-Rosas, MD*,
  3. David Reyes-Chiquete, MD*,
  4. Faride Chejne-Gómez, MD*,
  5. Andrea Plancarte, MD,
  6. Nadia I. González-Buendía, MD*,
  7. Oscar Cerezo-Camacho, MD, MS,
  8. Ángel Lee, MD§ and
  9. Roberto Medina-Santillan, MD, PhD
  1. From the *Clinic of Pain and Palliative Care Medicine, Instituto Nacional de Cancerología;
  2. Universidad Nacional Autónoma de México;
  3. Clinical Research Department, Instituto Nacional de Cancerología;
  4. §Department of Neurosurgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; and
  5. Department of Research and postgraduate studies, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico.
  1. Address correspondence to: Ricardo Plancarte, MD, FIPP, Clinic of Pain and Palliative Care Medicine, Instituto Nacional de Cancerología, Av San Fernando 22, Col. Sección XVI, 14060 Mexico City, Mexico (e-mail: planky2b{at}


Background: The use of celiac plexus block to relieve the intractable pain caused by upper abdominal malignancies is well established. However, its effects are inconsistent for many reasons, mainly because of structural anatomic distortion as a consequence for the malignancy. The splanchnic nerve blockade (SNB) seems to be a useful alternative to the celiac plexus block in upper abdominal pain relief.

Materials and Methods: The pain of 109 patients with unresectable upper abdominal or lower esophageal neoplasms was managed by posterior transdiscal SNBs guided by computed tomography at the Instituto Nacional de Cancerología in Mexico City from January 2004 to June 2007. The study evaluated SNB efficacy with regard to pain relief, its adverse effects/complications, and patient satisfaction.

Results: Splanchnic nerve blockade efficacy with regard to pain relief was exhibited by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from 6.1 ± 2.4 and 102.4 mg/d of morphine to 2.7 ± 2.4 and 53.3 mg/d at the first postprocedural visit, respectively. These results persisted during the 1-year follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (n = 64 and n = 47, respectively), and severe complications occurred in 1 patient with a transient paraparesis (n = 1). No procedure-related mortality was observed.

Conclusions: Splanchnic nerve blockade via a transdiscal approach is a technique that provides analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In experienced teams, the reliability of its analgesic effect is high, with a low rate of severe complications.

Abbreviations: CT - Computed tomography, SNB - splanchnic nerves neurolytic blockade, CPB - celiac plexus block, PSS - patient satisfaction scale, VAS - visual analog score

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