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Fudim M, Ponikowski PP, Burkhoff D, Dunlap ME, Sobotka PA, Molinger J, Patel MR, Felker GM, Hernandez AF, Litwin SE, Borlaug BA, Bapna A, Sievert H, Reddy VY, Engelman ZJ, Shah SJ. Splanchnic nerve modulation in heart failure: mechanistic overview, initial clinical experience, and safety considerations. Eur J Heart Fail 2021; 23:1076-1084. [PMID: 33886137 PMCID: PMC8298285 DOI: 10.1002/ejhf.2196] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022] Open
Abstract
Volume recruitment from the splanchnic compartment is an important physiological response to stressors such as physical activity and blood loss. In the setting of heart failure (HF), excess fluid redistribution from this compartment leads to increased cardiac filling pressures with limitation in exercise capacity. Recent evidence suggests that blocking neural activity of the greater splanchnic nerve (GSN) could have significant benefits in some patients with HF by reducing cardiac filling pressures and improving exercise capacity. However, to date the long-term safety of splanchnic nerve modulation (SNM) in the setting of HF is unknown. SNM is currently used in clinical practice to alleviate some forms of chronic abdominal pain. A systematic review of the series where permanent SNM was used as a treatment for chronic abdominal pain indicates that permanent SNM is well tolerated, with side-effects limited to transient diarrhoea or abdominal colic and transient hypotension. The pathophysiological role of the GSN in volume redistribution, the encouraging findings of acute and chronic pilot SNM studies and the safety profile from permanent SNM for pain provides a strong basis for continued efforts to study this therapeutic target in HF.
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Amr SA, Reyad RM, Othman AH, Mohamad MF, Mostafa MM, Alieldin NH, Hamed FA. Comparison between radiofrequency ablation and chemical neurolysis of thoracic splanchnic nerves for the management of abdominal cancer pain, randomized trial. Eur J Pain 2018; 22:1782-1790. [PMID: 29975804 DOI: 10.1002/ejp.1274] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) of the splanchnic nerves has been reported as a predictable and safe technique for abdominal pain management. We compare between RFA and chemical neurolysis of bilateral thoracic splanchnic nerves in the management of refractory cancer pain. METHODS The study was conducted on 60 patients aged ≥18 years who suffered from abdominal pain (visceral pain, VAS ≥4) due to upper abdominal cancers. Participants were randomized into two groups. Group I (RF): 30 participants received a bilateral splanchnic nerve block at T10 and T11 levels using RFA. Group II (alcohol): 30 participants received a bilateral splanchnic nerve block at T11 using alcohol. Pain relief was assessed using VAS (0-10) and total daily oral opioid consumption (primary outcome). RESULTS Significant reductions of VAS and global perceived effect satisfaction scores (GPES) were observed in both groups compared to baseline levels (p < 0.001); Group I had the largest reduction. MST consumption and QOL scores improved significantly in both groups (p < 0.001). Oral opioid consumption started to reduce at the end of the first post-interventional week for Group I, 0.00 (0-45 mg), and at the end of the second post-interventional week for Group II, 20.00 (0-135 mg). No major complications were recorded in either group. CONCLUSION Simultaneous bilateral pain block of splanchnic nerves at the levels of T10 and T11 using RFA is more effective than using alcohol at a single level of T11 in cancer patients presenting with upper abdominal pain. The RFA intervention acted faster, provided longer duration analgesia, worked in a higher proportion of patients and had a better safety profile than the alcohol intervention. SIGNIFICANCE Radiofrequency ablation of the splanchnic nerves is safe and effective for relieving upper abdominal cancer pain.
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Affiliation(s)
- S A Amr
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt
| | - R M Reyad
- Department of Anesthesia, and Pain Relief, National Cancer Institute, Cairo University, Egypt
| | - A H Othman
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt
| | - M F Mohamad
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt
| | - M M Mostafa
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt
| | - N H Alieldin
- Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Egypt
| | - F A Hamed
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt
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Shwita AH, Amr YM, Okab MI. Comparative Study of the Effects of the Retrocrural Celiac Plexus Block Versus Splanchnic Nerve Block, C-arm Guided, for Upper Gastrointestinal Tract Tumors on Pain Relief and the Quality of Life at a Six-month Follow Up. Korean J Pain 2015; 28:22-31. [PMID: 25589943 PMCID: PMC4293503 DOI: 10.3344/kjp.2015.28.1.22] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/06/2014] [Accepted: 11/17/2014] [Indexed: 12/20/2022] Open
Abstract
Background The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. Methods Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. Results Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. Conclusions The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.
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Affiliation(s)
- Amera H Shwita
- Department of Anesthesia and Pain Relief, Tanta Cancer Institute, Tanta, Egypt
| | - Yasser M Amr
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammad I Okab
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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Bhandari A, Ellias M. Loin pain hematuria syndrome: Pain control with RFA to the splanchanic plexus. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856900750233811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Verhaegh BPM, van Kleef M, Geurts JW, Puylaert M, van Zundert J, Kessels AGH, Masclee AAM, Keulemans YCA. Percutaneous radiofrequency ablation of the splanchnic nerves in patients with chronic pancreatitis: results of single and repeated procedures in 11 patients. Pain Pract 2013; 13:621-6. [PMID: 23301539 DOI: 10.1111/papr.12030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain is a major problem for chronic pancreatitis (CP) patients. Unfortunately, medical therapy often fails. Endoscopic and surgical treatments are invasive, and results vary. Percutaneous radiofrequency ablation of the splanchnic nerves (RFSN) is a relatively new and minimally invasive procedure for treatment of intractable pain in CP patients. MATERIALS AND METHODS We retrospectively evaluated 18 RFSN procedures in 11 CP patients, all refractory to analgesics. Five patients underwent a second procedure; two patients underwent a third procedure. NRS pain scores were assessed. Complications, analgesics usage, and length of the pain-free period were recorded. RESULTS Radiofrequency ablation of the splanchnic nerves was effective in 15/18 interventions. The mean NRS pain score decreased from 7.7 ± 1.0 to 2.8 ± 2.7 (P ≤ 0.001). The pain-free period lasted for a median period of 45 weeks. The effect of repeated interventions was comparable to the initial procedure. One transient side effect was reported. Four patients reported significantly reduced analgesic usage; 4 patients completely stopped their pain medication. CONCLUSION Radiofrequency ablation of the splanchnic nerves is a minimally invasive, effective procedure for pain relief. After the effect has subsided, RFSN can be successfully repeated. RFSN might become an alternative treatment in a selected group of CP patients. A larger, randomized trial is justified to substantiate these findings.
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Affiliation(s)
- Bas P M Verhaegh
- Department of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
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Soloman M, Mekhail MN, Mekhail N. Radiofrequency treatment in chronic pain. Expert Rev Neurother 2010; 10:469-74. [PMID: 20187867 DOI: 10.1586/ern.09.153] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic pain management physicians and patients are always looking for long-term solutions rather than short-lived interventions. There are three main nonsurgical modalities to ablate nervous system elements. These involve the use of extreme cold (cryoablation), high temperature radiofrequency and chemical neurolysis, such as alcohol or phenol. Radiofrequency ablation offers the advantage of being precise, reproducible and effective to a great extent. It also has the ability to stimulate before the ablation to avoid ablating the wrong nerve elements, which provides a considerable safety margin. In this article we will review the basis of radiofrequency ablation and some of the most common applications in the management of chronic pain.
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Affiliation(s)
- Marc Soloman
- Department of Pain Management, Cleveland Clinic, 9500 Euclid Ave (C25), Cleveland, OH 44195, USA.
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Affiliation(s)
- P Prithvi Raj
- Department of Anesthesiology, Texas Tech University Health Services Center, Lubbock, Texas 79414, USA
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Süleyman Ozyalçin N, Talu GK, Camlica H, Erdine S. Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain. Eur J Pain 2005; 8:539-45. [PMID: 15531222 DOI: 10.1016/j.ejpain.2004.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2003] [Accepted: 01/16/2004] [Indexed: 10/26/2022]
Abstract
Palliative treatment, pain therapy and quality of life (QOL) are very important in pancreatic cancer patients. We evaluated the pain relieving efficacy, side effects and effects on QOL of neurolytic coeliac plexus blockade (NCPB) and splanchnic nerves neurolytic blockade (SNB) in body and tail located pancreatic cancer. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Coeliac group; GC, N = 19 were treated with coeliac plexus blockade, whereas the patients in splanchnic group; GS, N = 20 were treated with bilateral splanchnic nerve blockade. The VAS values, opioid consumption and QOL (Patient satisfaction scale=PSS, performance status scale=PS) were evaluated prior to the procedure and at 2 weeks intervals after the procedure with the survival rates. The demographic features were found to be similar. The VAS differences (difference of every control's value with baseline value) in GS were significantly higher than the VAS differences in GC on every control meaning that VAS values in GS decreased more than the VAS values in GC. GS patients were found to decrease the opioid consumption significantly more than GC till the 6th control. GS patients had significant improvement in PS values at the first control. The mean survival rate was found to be significantly lower in GC. Two patients had severe pain during injection in GC and 5 patients had intractable diarrhoea in GC. Comparing the ease, pain relieving efficacy, QOL-effects of the methods, splanchnic nerve blocks may be an alternative to coeliac plexus blockade in patients with advanced body and tail located pancreatic cancer.
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Affiliation(s)
- N Süleyman Ozyalçin
- Department of Algology, Istanbul Medical Faculty, Istanbul University, Capa Klinikleri, 34390 Istanbul, Turkey
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Evrard S. Surgical lesioning of splanchnic nerves using wet needle radiofrequency thermoablation. J Surg Oncol 2002; 80:171-2. [PMID: 12115800 DOI: 10.1002/jso.10109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Serge Evrard
- Department of Surgery, Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France.
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