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Seong H, Yun D, Yoon KS, Kwak JS, Koh JC. Development of pre-procedure virtual simulation for challenging interventional procedures: an experimental study with clinical application. Korean J Pain 2022; 35:403-412. [PMID: 36175339 PMCID: PMC9530692 DOI: 10.3344/kjp.2022.35.4.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Most pain management techniques for challenging procedures are still performed under the guidance of the C-arm fluoroscope although it is sometimes difficult for even experienced clinicians to understand the modified three-dimensional anatomy as a two-dimensional X-ray image. To overcome these difficulties, the development of a virtual simulator may be helpful. Therefore, in this study, the authors developed a virtual simulator and presented its clinical application cases. Methods We developed a computer program to simulate the actual environment of the procedure. Computed tomography (CT) Digital Imaging and Communications in Medicine (DICOM) data were used for the simulations. Virtual needle placement was simulated at the most appropriate position for a successful block. Using a virtual C-arm, the authors searched for the position of the C-arm at which the needle was visualized as a point. The positional relationships between the anatomy of the patient and the needle were identified. Results For the simulations, the CT DICOM data of patients who visited the outpatient clinic was used. When the patients revisited the clinic, images similar to the simulated images were obtained by manipulating the C-arm. Transforaminal epidural injection, which was difficult to perform due to severe spinal deformity, and the challenging procedures of the superior hypogastric plexus block and Gasserian ganglion block, were successfully performed with the help of the simulation. Conclusions We created a pre-procedural virtual simulation and demonstrated its successful application in patients who are expected to undergo challenging procedures.
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Affiliation(s)
- Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Daehun Yun
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Kyung Seob Yoon
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ji Soo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea
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Abdelghafar EM, Othman AH, Soliman MS, Kilany A, Shaaban MH, Shaker EH. The Role of Double Modality Ultrasonographic and Fluoroscopic Guided Superior Hypogastric Plexus Neurolysis in Treating Intractable Pelvic Cancer Pain: A Comparative Study. J Pain Res 2021; 14:1465-1473. [PMID: 34079361 PMCID: PMC8166312 DOI: 10.2147/jpr.s308743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Superior hypogastric neurolytic block is performed to block visceral pelvic pain. This could be performed through the anterior approach guided by CT or ultrasound and through a posterior approach, guided by fluoroscopy or CT. Methods Sixty adult patients with severe visceral pelvic pain (VAS>70 mm) were randomly divided into two groups. Group S: SHP block was done ultrasound guided using the anterior approach and confirmed by fluoroscopy. Group F: SHP block was done fluoroscopic guided using the posterior oblique approach. The VAS (visual analog scale), duration of the technique, time of X-ray exposure, patient satisfaction score, patient global impression of change (PGIC), quality of life score, and daily morphine consumption (mg/day) were measured pre-procedure and at the 1st, 4th, 8th, and 12th week after the procedure. In addition, any side effects of the procedure were recorded. Results There was a significant difference in VAS between the two groups (P<0.01) (better in group S). The quality of life score was improved from the pre-procedure in both groups (P<0.05), and morphine consumption was significantly lower in group S than in group F (P<0.05) at the 1st, 4th, and 8th week and not significant at the 12th week. The two groups show a statistically significant difference as regards the duration of the procedure and X-ray exposure (P<0.01). There was a statistically significant difference in the satisfactory score between the two groups at the 1st, 4th, 8th, and 12th week (P<0.01). As regards the PGIC score, there was no statistically significant difference between the two groups (P>0.05). In group S, no back pain was reported, while 11 patients of group F complained from post-procedure back pain (P<0.001). Conclusion The anterior ultrasound guided SHPB aided by fluoroscopy is suggested to be more superior to the standard fluoroscopic guided technique in relieving pelvic cancer pain and decreasing morphine consumption.
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Affiliation(s)
- Ekramy M Abdelghafar
- Department of Anesthesia, ICU And Pain Relief, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed H Othman
- Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Mahmoud Salem Soliman
- Department of Anesthesia, Critical Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Kilany
- Department of Research on Children with Special Needs, National Research Center, Cairo, Egypt
| | - Mohammed H Shaaban
- Department of Diagnostic & Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ehab H Shaker
- Department of Anesthesia, ICU And Pain Relief, National Cancer Institute, Cairo University, Cairo, Egypt
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Urits I, Schwartz R, Herman J, Berger AA, Lee D, Lee C, Zamarripa AM, Slovek A, Habib K, Manchikanti L, Kaye AD, Viswanath O. A Comprehensive Update of the Superior Hypogastric Block for the Management of Chronic Pelvic Pain. Curr Pain Headache Rep 2021; 25:13. [PMID: 33630172 DOI: 10.1007/s11916-020-00933-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain. RECENT FINDINGS Several definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6 months in the pelvis, with an overwhelming majority of patients being reproductive-aged women. This pain is often one of mechanical, inflammatory, or neuropathic. It is generally underdiagnosed and affects anywhere between 5 and 26% of women. The diagnosis of chronic pelvic pain is clinical, consisting of mainly of a thorough history and physical and ruling out other causes. The pathophysiology is often endometriosis (70%) and also includes PID, adhesions, adenomyosis, uterine fibroids, chronic processes of the GI and urinary tracts, as well as pelvic-intrinsic musculoskeletal causes. Treatment includes physical therapy, cognitive behavioral therapy, and oral and parenteral opioids. Interventional techniques provide an added tier of treatment and may help to reduce the requirement for chronic opioid use. Superior hypogastric plexus block is one of the available interventional techniques; first described in 1990, it has been shown to provide long-lasting relief in 50-70% of patients who underwent the procedure. Two approaches described so far, both under fluoroscopy, have seen similar results. More recently, ultrasound and CT-guided procedures have also been described with similar success. The injectate includes local anesthetic, steroids, and neurolytic agents such as phenol or ethanol. CPP is a common debilitating condition. It is diagnosed clinically and is underdiagnosed globally. Current treatments can be helpful at times but may fall short of satisfactory pain relief. Interventional techniques provide an added layer of treatment as well as reduce the requirement for opioids. Superior hypogastric plexus block provides long-lasting relief in many patients, regardless of approach. Evidence level is limited, and further RCTs could help provide better tools for evaluation and patient selection.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Jared Herman
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - David Lee
- Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Christopher Lee
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
| | - Alec M Zamarripa
- Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Annabel Slovek
- Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| | - Kelly Habib
- Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA, USA.,Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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Ding XF, Huang TB, Lu SM, Tao HZ, Ye XF, Wang F, Xu YZ, Xu JN, Zhou YQ, Luan Y. Pelvic plexus block to provide better anesthesia in transperineal template-guided prostate biopsy: a randomised controlled trial. BMC Urol 2019; 19:63. [PMID: 31288778 PMCID: PMC6617827 DOI: 10.1186/s12894-019-0496-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 07/04/2019] [Indexed: 01/25/2023] Open
Abstract
Background To evaluate the efficacy of pelvic plexus block (PPB) in relief pain during transperineal template-guided prostate biopsy (TTPB), compared with conventional periprostatic nerve block (PNB). Methods From July 2016 to August 2017, 245 patients who were performed TTPB in Clinical Medical College of Yangzhou University were recruited. The patients were randomized into three groups using a random number table. Group-1 received prostate capsule local anesthesia with 22 ml of 1% lidocaine. Group-2 additionally received PNB on the basis of Group-1. To perform PNB, 5 ml 1% lidocaine was injected into the region of prostatic neurovascular bundle situated in the angle of prostate-bladder-seminal vesicle. Group-3 received prostate capsule local anesthesia plus PPB (5 ml of 1% lidocaine injection into the pelvic plexus which located on lateral to the bilateral seminal vesicle apex). The patients’ pain and satisfaction were evaluated by visual analogue scale and visual numerical scale, respectively. Results The age, total prostate volume, PSA and the number of cores were comparable among the three groups. The visual analog scale scores of group-3 were significantly lower than group-2 during biopsy (P = 0.003). Conversely, the visual numeric scale scores were higher in group-3 (P = 0.039). Both the group-2 and group-3 outperformed the group-1 in alleviating pain and had a higher quantification of satisfaction. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure among the three groups. Conclusions The analgesic efficacy of PPB guided by Doppler ultrasound in TTPB was better than that of PNB and both were superior to no nerve block. Trial registration ChiCTR-IOR-17013533, 01/06/2016.
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Affiliation(s)
- Xue-Fei Ding
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Tian-Bao Huang
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Sheng-Ming Lu
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Hua-Zhi Tao
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Xiao-Fang Ye
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Fei Wang
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Yao-Zong Xu
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Jia-Nan Xu
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Yu-Quan Zhou
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China
| | - Yang Luan
- Department of Urology, Clinical Medical College, Yangzhou University, No. 98 West Nantong Road, Yangzhou, Jiangsu Province, 225001, China. .,Department of Urology, Taihe County People's Hospital, Fuyang, 226600, Anhui Province, China.
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Aytuluk HG, Kale A, Basol G. Laparoscopic Superior Hypogastric Blocks for Postoperative Pain Management in Hysterectomies: A New Technique for Superior Hypogastric Blocks. J Minim Invasive Gynecol 2019; 26:740-747. [DOI: 10.1016/j.jmig.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 01/22/2023]
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