Ultrasound versus Fluoroscopic-Guided Superior Hypogastric Plexus Block in Cancer Bladder: A Randomized Controlled Trial

Asmaa Elsayed Khalil; Ikram Hamed Mahmoud; Dina Nabil Abbas; Mamdouh Mahmoud Mostafa; Ahmed Mohamed Soliman Idris; Khaled Abdel Hamed Mostafa

doi:10.3889/oamjms.2023.8581

Authors

Asmaa Elsayed Khalil Department of Anesthesiology, ICU and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
Ikram Hamed Mahmoud Department of Radiodiagnosis, National Cancer Institute, Cairo University, Giza, Egypt
Dina Nabil Abbas Department of Anesthesiology, ICU and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
Mamdouh Mahmoud Mostafa Department of Anesthesiology, ICU and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
Ahmed Mohamed Soliman Idris Department of Anesthesiology, ICU and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt
Khaled Abdel Hamed Mostafa Department of Anesthesiology, ICU and Pain Management, National Cancer Institute, Cairo University, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2023.8581

Keywords:

Fluoroscopy, Hypogastric plexus, Pain measurement, Pelvic pain, Ultrasonography (US)

Abstract

BACKGROUND: Patients with advanced bladder cancer may suffer severe pelvic pain unresponsive to standard pharmacological therapy.

AIM: This study assessed the feasibility, efficacy of ultrasoundguided (USG) versus fluoroscopy-guided (FG) superior hypogastric plexus block (SHPB) in bladder cancer pain management.

METHODS: This randomized controlled study included 60 patients undergoing SHPB to manage pain in stages 3 and 4 bladder cancer patients from December 2020 to June 2021. They were randomly divided into two groups. Group Fluoro (n = 30) underwent FG-SHPB, while Group US (n = 30) underwent US-SHPB. The patients were assessed after 1 day and 1 and 3 months regarding pain intensity using visual analog score (VAS), daily morphine consumption, functional capacity, and quality of life (QoL) using the Short Form Health Survey-36.

RESULTS: The procedure failed in 2 patients in each group. The procedure was significantly lengthier in the Fluor group than the US group (p < 0.001). VAS scores decreased significantly in the two groups after 1 and 3 months and were significantly in US-SHBP after 3 months. Morphine consumption decreased significantly, and functional capacity and QoL improved significantly in both groups up to 3 months. The two groups were comparable in morphine consumption, functional capacity, and QoL. Position discomfort and back pain were more common in Fluor Group.

CONCLUSION: USG SHPB is a feasible, safe, and effective analgesic procedure in patients with advanced bladder cancer suffering from severe pelvic pain. It is superior to the FG transdiscal approach regarding the duration of pain relief and improvement of functional capacity in addition to avoidance of position discomfort and back pain.

REGISTRATION: Clinical Trials.gov (ID NCT05083702).

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492 PMid:30207593

Religioni U, Czerw A, Deptala A. Assessment of pain, acceptance of illness, adaptation to life, and strategies of coping with the disease, in patients with bladder cancer. In vivo. 2021;35(2):1157-61. https://doi.org/10.21873/invivo.12363 PMid:33622915

Saini S, Bhatnagar S. Cancer pain management in developing countries. Indian J Palliat Care. 2016;22(4):373-7. https://doi.org/10.4103/0973-1075.191742 PMid:27803557

Van den Beuken-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. J Pain Symptom Manage. 2016;51(6):1070-90.e9. https://doi.org/10.1016/j.jpainsymman.2015.12.340 PMid:27112310

Kwon JH. Overcoming barriers in cancer pain management. J Clin Oncol. 2014;32(16):1727-33. https://doi.org/10.1200/JCO.2013.52.4827 PMid:24799490

Zaza C, Baine N. Cancer pain and psychosocial factors: A critical review of the literature. J Pain Symptom Manage. 2002;24(5):526-42. https://doi.org/10.1016/ s0885-3924(02)00497-9 PMid:12547052

Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, et al. Quality of cancer pain management: An update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014;32(36):4149-54. https://doi.org/10.1200/JCO.2014.56.0383 PMid:25403222

Reis-Pina P, Lawlor PG, Barbosa A. Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic. J Pain Res. 2017;10:2097-107. https://doi.org/10.2147/JPR.S139715 PMid:28919809

World Health Organization. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization; 2018. Available from: https://apps.who.int/iris/handle/10665/279700 [Last accessed on 2021 Nov 22].

Mishra S, Bhatnagar S, Rana SP, Khurana D, Thulkar S. Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients. Pain Med. 2013;14(6):837-42. https://doi.org/10.1111/pme.12106 PMid:23577819

Caraceni A, Portenoy RK, A Working Group of the IASP Task Force on Cancer Pain. An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. International Association for the Study of Pain. Pain. 1999;82(3):263-74. https://doi.org/10.1016/ S0304-3959(99)00073-1 PMid:10488677

Ahmed DG, Mohamed MF, Mohamed SA. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief. Pain Physician. 2015;18(1):E49-56. PMid:25675070

Margulis I, Gulati A. Genitourinary cancer pain syndromes. In: Gulati A, Puttanniah V, Bruel BM, Rosenberg WS, Hung JC, editors. Essentials of Interventional Cancer Pain Management. Cham: Springer International Publishing; 2019. p. 107-12. Available from: https://link.springer.com/10.1007/978-3-319-99684-4_12 [Last accessed on 2021 Nov 22].

Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-4. https://doi.org/10.1245/s10434-010-0985-4 PMid:20180029

Gamal G, Helaly M, Labib YM. Superior hypogastric block: Transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 2006;22(6):544-7. https://doi.org/10.1097/01.ajp.0000202978.06045.24 PMid:16788341

Mishra S, Bhatnagar S, Gupta D, Thulkar S. Anterior ultrasound- guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care. 2008;36(5):732-5. https://doi.org/10.1177/0310057X0803600518 PMid:18853596

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55. PMid:7165009

Adorno ML, Brasil-Neto JP. Assessment of the quality of life through the SF-36 questionnaire in patients with chronic nonspecific low back pain. Acta Ortop Bras. 2013;21(4):202-7. https://doi.org/10.1590/S1413-78522013000400004 PMid:24453669

Ware JE Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-83. PMid:1593914

Sakpal TV. Sample size estimation in clinical trial. Perspect Clin Res. 2010;1(2):67-9. PMid:21829786

Dawson-Saunders B, Trapp RG. Basic and Clinical Biostatistics. United States: McGraw-Hill Education/Medical; 2005.

Nabil D, Eissa AA. Evaluation of posteromedial transdiscal superior hypogastric block after failure of the classic approach. Clin J Pain. 2010;26(8):694-7. https://doi.org/10.1097/AJP.0b013e3181dedfa9 PMid:20664339

Bosscher H. Blockade of the superior hypogastric plexus block for visceral pelvic pain. Pain Pract. 2001;1(2):162-70. https://doi.org/10.1046/j.1533-2500.2001.01017.x PMid:17129292

Nauck F. Cancer pain therapy. Urol Ausg A. 2009;48:1175-6, 1178-81.

Carr DB, Goudas LC, Balk EM, Bloch R, Ioannidis JP, Lau J. Evidence report on the treatment of pain in cancer patients. J Natl Cancer Inst Monogr. 2004;32:23-31. https://doi.org/10.1093/jncimonographs/lgh012 PMid:15263038

Kanazi GE, Perkins FM, Thakur R, Dotson E. New technique for superior hypogastric plexus block. Reg Anesth Pain Med. 1999;24(5):473-6. https://doi.org/10.1016/s1098-7339(99)90018-4 PMid:10499763

Bhaskar A. Interventional pain management in patients with cancer-related pain. Postgrad Med. 2020;132(Sup 3):13-6. https://doi.org/10.1080/00325481.2020.1807796 PMid:32799614

Vissers KC, Besse K, Wagemans M, Zuurmond W, Giezeman MJ, Lataster A, et al. Pain in patients with cancer. Pain Pract. 2011;11(5):453-75. https://doi.org/10.1111/j.1533-2500.2011.00473.x PMid:21679293

Urits I, Schwartz R, Siddaiah HB, Kikkeri S, Chernobylsky D, Charipova K, et al. Inferior hypogastric block for the treatment of chronic pelvic pain. Anesthesiol Pain Med. 2021;11(1):e112225. https://doi.org/10.5812/aapm.112225 PMid:34221944

Urits I, Jones MR, Orhurhu V, Peck J, Corrigan D, Hubble A, et al. A comprehensive review of the celiac plexus block for the management of chronic abdominal pain. Curr Pain Headache Rep. 2020;24(8):42. https://doi.org/10.1007/s11916-020-00878-4 PMid:32529305

Khodaverdi S, Alebouyeh MR, Sadegi K, Mehdizadehkashi A, Kaveh M, Entezari SR, et al. Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: An open-label pilot clinical trial. J Obstet Gynaecol. 2021;41(6):966-71. https://doi.org/10.1080/01443615.2020.1820468 PMid:33243036

Schmidt AP, Schmidt SR, Ribeiro SM. Is superior hypogastric plexus block effective for treatment of chronic pelvic pain? Rev Bras Anestesiol. 2005;55(6):669-79. https://doi.org/10.1590/s0034-70942005000600011 PMid:19468542

Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990;73(2):236-9. https://doi.org/10.1097/00000542-199008000-00008 PMid:2382849

Waldman SD, Wilson WL, Kreps RD. Superior hypogastric plexus block using a single needle and computed tomography guidance: Description of a modified technique. Reg Anesth. 1991;16(5):286-7. PMid:1958609

Michalek P, Dutka J. Computed tomography-guided anterior approach to the superior hypogastric plexus for noncancer pelvic pain: A report of two cases. Clin J Pain. 2005;21(6):553-6. https://doi.org/10.1097/01.ajp.0000146214.08910.21 PMid:16215342

Erdine S, Yucel A, Celik M, Talu GK. Transdiscal approach for hypogastric plexus block. Reg Anesth Pain Med. 2003;28(4):304-8. https://doi.org/10.1016/s1098-7339(03)00191-3 PMid:12945023

Turker G, Basagan-Mogol E, Gurbet A, Ozturk C, Uckunkaya N, Sahin S. A new technique for superior hypogastric plexus block: The posteromedian transdiscal approach. Tohoku J Exp Med. 2005;206(3):277-81. https://doi.org/10.1620/tjem.206.277 PMid:15942158

Dooley J, Beadles C, Ho KY, Sair F, Gray-Leithe L, Huh B. Computed tomography-guided bilateral transdiscal superior hypogastric plexus neurolysis. Pain Med. 2008;9(3):345-7. https://doi.org/10.1111/j.1526-4637.2006.00291.x PMid:18366511

Nobles RH, Hillegass MG. Superior Hypogastric Plexus Block. In: Yong RJ, Nguyen M, Nelson E, Urman RD, editors. Pain Medicine. Cham: Springer International Publishing; 2017 p. 297-300. https://doi.org/10.1007/978-3-319-43133-8_81

Liliang PC, Hung CM, Lu K, Chen HJ. Fluoroscopically-guided superior hypogastric plexus neurolysis using a single needle: A modified technique for a posterolateral transdiscal approach. Pain Physician. 2018;21(4):E341-5. PMid:30045600

Kamel MA, Ahmed AS, Shaaban MH, Hashem RH. Comparison between fluoroscopic posterior versus ultrasound- guided anterior approach for superior hypogastric plexus neurolysis: A prospective, randomized, comparative study. Res Opin Anesth Intensive Care. 2016;3(4):151-6. https://doi.org/10.4103/2356-9115.195882

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;14:1465-73. https://doi.org/10.2147/JPR.S308743 PMid:34079361

Gofeld M, Lee CW. Ultrasound-guided superior hypogastric plexus block: A cadaveric feasibility study with fluoroscopic confirmation. Pain Pract. 2017;17(2):192-6. https://doi.org/10.1111/papr.12437 PMid:26945508