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

Background and Objectives. Neurolytic superior hypogastric plexus bloc k has been shown to be safe and effective in selected cancer patients. A large cohort of patients was studied to evaluate the continued effi cacy and safety of this block in cancer patients with advanced disease . Methods. A total of 227 pelvic pain patients with gynecological, col orectal, or genitourinary cancer who experienced poor pain control due to either progression of disease or to untoward side effects were enr olled in this study during a 3-year period. All pain patients receivin g oral opioids were eligible to participate. A bilateral percutaneous neurolytic superior hypogastric plexus block with 10% phenol was perfo rmed 1 day after a successful diagnostic block with 0.25% bupivacaine. Results. All patients reported a visual analog scale (VAS) pain score of 7-10/10 before the block. A positive response to a diagnostic bloc k was obtained in 159 patients (79%). Overall, 115 patients of the 159 patients who responded to a diagnostic block (72%, 95% confidence int erval of 65-79%) had satisfactory pain relief (VAS < 4/10), 99 (62%) a fter one block, and 16 (10%) after a second block. The remaining 44 pa tients (28%) had moderate pain control (VAS 4-7/10) after two blocks a nd received oral pharmacological therapy and epidural analgesic therap y with good results. Both groups 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 3 months. No complications related io the block were detecte d. Conclusions. Neurolytic superior hypogastric plexus block provided both effective pain relief and a significant reduction in opioid usage (43%) in 72% of the patients who received a neurolytic block. Overall , this represents 51% of the patients enrolled in the study. Poor resu lts should he expected in patients with extensive retroperitoneal dise ase overlying the plexus because of inadequate spread of the neurolyti c agent.