Splanchnic nerve neurolysis: promising tool for treatment of cancer pain of the upper abdomen

Written By : Dr Monish Raut |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-01-03T04:00:35+05:30 | Updated On 3 Jan 2024 4:01 AM IST

The research paper presents a systematic review and meta-analysis evaluating the analgesic efficacy of neurolytic splanchnic nerve block (NSNB) in treating chronic upper abdominal pain caused by malignancies involving the liver, gall bladder, stomach, and pancreas. The study also assesses the impact of NSNB on quality of life, opioid consumption, procedural safety, and patient survival. The review includes the use of structured Population, Intervention, Control, Outcome, Study (PICOS) criteria to select relevant studies and incorporates a comprehensive literature search of various databases.

The primary objective of the review was to evaluate the analgesic efficacy of NSNB, while the secondary objectives included the impact on quality of life, opioid consumption, procedural safety, and patient survival. The review included studies investigating NSNB for chronic abdominal pain unresponsive to conservative treatment, including randomised controlled trials (RCTs) and non-randomised before-and-after studies from 2001 to 2022. The studies were evaluated for methodological quality and underwent a comprehensive data analysis using a random-effect model with an inverse variance method. The review found that NSNB provided significant pain relief, reduced opioid consumption, and improved quality of life with minimal procedure-related complications.

Study Findings and Heterogeneity

Additionally, the review revealed substantial heterogeneity in the included studies due to differences in participant characteristics, disease severity, comorbidities, treatment responses, and methodological variations. The review highlights the need for high-quality multicentric clinical trials with larger sample sizes and substantial follow-up evaluations to strengthen the evidence and address the identified limitations in the current literature.

Conclusion and Further Research

In conclusion, the review suggests that NSNB is a promising intervention for chronic upper abdominal pain, but further high-quality research is needed to enhance the predictive strength of the evidence and validate the efficacy of NSNB in improving patient outcomes. No conflicts of interest were reported by the authors.

Reference-

Goyal, Sonal1; Kumar, Ajit2; Goyal, Divakar3; Attar, Pradeep2; Bhandari, Baibhav2; Purohit, Gaurav4; Mahiswar, Aditya Pal5; Gupta, Shiwam2. Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis. Indian Journal of Anaesthesia 67(12):p 1036-1050, December 2023. | DOI: 10.4103/ija.ija_439_23

Abdominal painchemical neurolysischronic painintractable painneoplasmsneurolysisopioidquality of lifesplanchnic nerve blocksympathetic

Dr Monish Raut

MBBS, MD (Anaesthesiology), FNB (Cardiac Anaesthesiology)

Dr Monish Raut is a practicing Cardiac Anesthesiologist. He completed his MBBS at Government Medical College, Nagpur, and pursued his MD in Anesthesiology at BJ Medical College, Pune. Further specializing in Cardiac Anesthesiology, Dr Raut earned his FNB in Cardiac Anesthesiology from Sir Ganga Ram Hospital, Delhi.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751