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Efficacy of the Anterior Ultrasound-Guided Superior Hypogastric Plexus Neurolysis in Pelvic Cancer Pain in Advanced Gynecological Cancer Patients

Authors

  • Seema Mishra MD,

    Corresponding author
    • Unit of Anaesthesiology, Dr. B.R.Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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  • Sushma Bhatnagar MD,

    1. Unit of Anaesthesiology, Dr. B.R.Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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  • Shiv P. S. Rana MD,

    1. Unit of Anaesthesiology, Dr. B.R.Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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  • Deepa Khurana MD,

    1. Unit of Anaesthesiology, Dr. B.R.Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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  • Sanjay Thulkar MD

    1. Unit of Anaesthesiology, Dr. B.R.Ambedkar, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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  • Funding: This study was funded by All Instititue of Medical Sciences Research Grant.
  • Conflict of Interest: The authors have no conflict of interest to report.

Reprint requests to: Seema Mishra, MD, AIIMS Residential Campus (East), Ansari Nagar, New Delhi-110029, India. Tel: +91-9899061105; Fax: 91-11-26588641; E-mail: seemamishra2003@gmail.com.

Abstract

Background and Aims

Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in gynecological cancer patients.

Material & Methods

The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided superior hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects.

Results

There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P < 0.05) greater. The daily morphine consumption in Group II decreased throughout the study, and more patients in Group II improved in their functional capacity, although it was statistically insignificant. It was observed that global satisfaction scores were better in Group II during the initial first (P = 0.001) week and 1 month (P = 0.04) compared with Group I.

Conclusion

The anterior USG-guided superior hypogastric plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided superior hypogastric block.

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