NEUROLYTIC SUPERIOR HYPOGASTRIC PLEXUS BLOCK FOR CHRONIC PELVIC PAIN ASSOCIATED WITH CANCER

Twenty-six patients with extensive gynecologic, colorectal or genitour inary cancer who suffered uncontrolled, incapacitating pelvic pain wer e enrolled in this study during a 1-year period. All the patients rece iving oral opioids who developed poor pain response due to the progres sion of disease or untoward side effects necessitating other modes of therapy were eligible to participate. Bilateral percutaneous neurolyti c superior hypogastric plexus blocks with 10% phenol were performed in every patient, 1 day after receiving successful diagnostic blocks usi ng 0.25% bupivacaine (BUP). All patients reported a visual analog pain score (VAPS) of 10 of 10 before the block. Eighteen patients (69%) ha d satisfactory pain relief (VAPS < 4 of 10): 15 (57%) after 1 block an d 3 (12%) after a second block. The remaining 8 patients (31%) had mod erate pain control (VAPS 4-7 of 10) after 2 blocks and received epidur al bupivacaine-morphine (BUP-MS) therapy with good results. Both group s 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 6 months. No complica tions related to the block were experienced by any patient. In conclus ion, neurolytic superior hypogastric plexus block was both effective i n relieving pain in 69% of the patients studied (95% confidence interv al of 48-85%). Additional neurolytic blocks using higher volumes of th e neurolytic agent may be needed in patients with extensive retroperit oneal disease, a group in whom moderate or poor results should be expe cted.