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Sushma Bhatnagar - One of the best experts on this subject based on the ideXlab platform.
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early ultrasound guided neurolysis for pain management in gastrointestinal and pelvic malignancies an observational study in a tertiary care center of urban india
Pain Practice, 2012Co-Authors: Sandeep Khanna, Seema Mishra, Sushma Bhatnagar, S Roshni, Gaurav Nirwani Goyal, Shiv Pratap Singh Rana, Sanjay ThulkarAbstract:: Patients with advanced gastrointestinal and pelvic malignancies commonly present with pain of varying severity. In a majority of these patients, pain can be effectively managed using an integrated systemic pharmacological approach with oral morphine being the cornerstone of treatment. However, with escalating doses, intolerable side effects of oral morphine may lead to patient dissatisfaction. When oral pharmacotherapy fails to adequately address the issue of pain or leads to insufferable side effects, neurolytic blocks of the sympathetic axis are usually used for pain alleviation. As these blocks may reduce oral analgesic requirement, a reevaluation of their timing is merited. This article presents our hospital-based in-patient palliative care unit experience with early ultrasonography-guided neurolysis of celiac plexus, superior hypogastric plexus and Ganglion Impar. Of the 44 patients we studied, 20 underwent celiac plexus neurolysis, 18 superior hypogastric plexus neurolysis, and 6 Ganglion Impar neurolysis. Their pain was being managed with oral morphine before neurolysis, but only 11.4% patients required oral morphine for satisfactory pain control, 2 months after neurolysis. The mean Visual Analog Scale score before block placement was 5.64 ± 0.69 and fell to 2.25 ± 1.33 at 2 months post neurolysis (P < 0.001). We suggest that bedside ultrasonography-guided sympathetic axis neurolysis may be employed early in patients with incurable abdominal or pelvic cancer. Its use as a first-line intervention for achieving pain control with minimal complications warrants further consideration and investigation. ▪
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Ultrasonography reinvents the originally described technique for Ganglion Impar neurolysis in perianal cancer pain.
Anesthesia & Analgesia, 2008Co-Authors: Deepak Gupta, R. K. Jain, Seema Mishra, Surender Kumar, Sanjay Thulkar, Sushma BhatnagarAbstract:Visceral pain in the perineal area associated with malignancies may be effectively treated with neurolysis of the Ganglion Impar. Since the first description of the technique of accessing the Ganglion Impar through anococcygeal ligament, many techniques for Ganglion Impar block have been described. We present a patient diagnosed with carcinoma of the anal canal who was successfully given ultrasound-guided Ganglion Impar block using a Chiba needle inserted through the anococcygeal ligament. In summary, ultrasound-guided Ganglion Impar neurolysis is a fast, safe, and cost-effective method, which can be used as a first-line pain relief intervention for good quality of life in patients with perianal cancers.
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Pakter Curved Needle Set refines Ultrasound Guided Ganglion Impar Neurolysis
The Internet Journal of Anesthesiology, 2007Co-Authors: Deepak Gupta, Seema Mishra, Sanjay Thulkar, Narendra Babu, Himanshu Khurana, Sushma BhatnagarAbstract:IMPLICATIONS STATEMENT Technically Pakter Curved Needle Set can improve the success of the ultrasound guided Ganglion Impar neurolysis by more posterior projection of curved needle onto the anterior surface of coccyx.
Keun Man Shin - One of the best experts on this subject based on the ideXlab platform.
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Stereotactic Neurotomy of the Ganglion Impar through the Sacrococcygeal Junction in Cancer-Related Perianal Pain- A case report -
The Korean Journal of Pain, 2005Co-Authors: Keun Sook Kim, Sung Mi Hwang, So Young Lim, Soon Yong Hong, Keun Man ShinAbstract:The Ganglion Impar is a solitary retroperitoneal structure at the caudal end of the paravertebral sympathetic chain. Block of this Ganglion has been advocated as a means of managing intractable perineal pain. In 1990, Plancarte et al performed a neurolytic block of the Ganglion Impar using 4 6 ml of 10% phenol through the intergluteal skin over the anococcygeal ligament. However, technical difficulties are encountered with the placement of the needle while performing this technique, with complications from the injection of phenol also being a possibility. In 1995, a modified approach for blocking the Ganglion Impar through the sacrococcygeal ligament was introduced by Wemm and Saberski. We used a radiofrequency (RF) lesion generator to create a controlled and localized lesion with a lower incidence of neural damages compared to chemical neurolysis. RF thermocoagulation of the Ganglion Impar through the sacrococcygeal ligament was performed on a 70-year-old male patient with constant anal pain using a curved TEW electrode. The patient has been relieved of his pain, without serious complication. Therefore, this technique may be an easier and safer approach, which is associated with fewer chances of complications.
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Ganglion Impar block in the management of rectal tenesmoid pain
The Korean Journal of Pain, 1996Co-Authors: Soo Kwan Kim, So Young Lim, Soon Yong Hong, Keun Man Shin, Yongroew Cho, Cheol Soo Ahn, Youngryong ChoiAbstract:Rectal tenesmus is a persistent, painful and ineffectual sensation of straining at stool or opening of the bowels. The pain is usually spasmodic in nature and most commonly en- countered in patients with carcinoma of the rectum or other pelvic organs. In 1988, Bristowand Foster reported that patients with severe spasmodic painful tenesmus were relieved with chemical sympathectomy. In 1990, Plancarte introduced block of Gangli- on Impar. This technique is proposed as an alternative means of managin#g localized peri- neal pain of sympathetic origin. Ganglion Impar block was performed on a 54-year-old female patient when analgesic or psychotropic drugs failed to control the symptoms of post-traumatic severe spasmodic pain- ful tenesmus. Postoperatively, patient was free of tenesmoid pain for only 7 days. We then performed neurotomy by RF lesion generator which provided complete pain relief.
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stereotaxic neurotomy of the Ganglion Impar in the management of perineal pain a case report
The Korean Journal of Pain, 1996Co-Authors: Keun Man Shin, So Young Lim, Soon Yong Hong, Jinsoo Kim, Yongroew Cho, Youngryong ChoiAbstract:The first reported the neural blockade of Ganglion Impar for pain control of perineal pain in 1990 by Plancarte and his fellows. they used 6ml of 10 percent phenol. but the point of issues, same as other neurolytics, are that it is impossible to check and control its spreading, so it might be possible to destruct the coccygeal plexus and sacral nerve, and also it has only short action time. Because of these problems, it could be very dangerous to attempt this procedure especially not for relieving the pain on cancer terminal patient, but for the sympathectomy of Ganglion Impar on the other purpose. We used the RF generator which had the control ability to point out the destructive lesion accurately. inserted We made the small burr hole on the sacrum near the sacrococcygeal junction directly, through the hole, and performed thermocoagulation to the Ganglion Impar.
R Contreras - One of the best experts on this subject based on the ideXlab platform.
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thermocoagulation of the Ganglion Impar or Ganglion of walther description of a modified approach preliminary results in chronic nononcological pain
Pain Practice, 2005Co-Authors: Enrique Reig, David Abejon, Cristina Del Pozo, J Insausti, R ContrerasAbstract:: The Ganglion Impar, a single structure usually found at the anterior aspect of the sacrococcygeal joint, is the lowest Ganglion of the paravertebral sympathetic chain. Its blockade is indicated in visceral pain syndromes and/or sympathetic pain syndromes of the perineal region. Several approaches to this block have been described, mainly through the anococcygeal or sacrococcygeal ligaments. We propose a modified approach to thermocoagulation of the Ganglion Impar, using a two-needle technique, the first one, placed through the sacrococcygeal ligament, the transsacrococcygeal needle, and the second one through a coccygeal disc, the transdiscal needle. The thermocoagulation technique that we employ uses a conventional radiofrequency application of 80°C for 80 seconds through each needle. In this prospective study, 13 patients with chronic perineal, noncancer-related pain were followed for a maximum of 6 months. All of these patients underwent diagnostic Ganglion Impar block with local anesthetic prior to inducing neurodestruction with conventional radiofrequency application, as a positive result to the diagnostic local anesthetic block was a requisite for radiofrequency neurodestruction. We measured pain using a visual analog scale (VAS) before and after treatment. Statistical significance was assessed using the Mann–Whitney U-test and Wilcoxon range summation test. Initially the VAS was equal to or greater than 7. After therapy the VAS decreased by an average of 50% in the whole group. There were no adverse events. Our result show that this proposed modified approach to the block and use of radiofrequency for the Ganglion Impar is useful for the treatment of perineal noncancer-related pain.
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thermocoagulation of the Ganglion Impar or Ganglion of walther description of a modified approach preliminary results in chronic nononcological pain
Pain Practice, 2005Co-Authors: Enrique Reig, David Abejon, Cristina Del Pozo, J Insausti, R ContrerasAbstract:The Ganglion Impar, a single structure usually found at the anterior aspect of the sacrococcygeal joint, is the lowest Ganglion of the paravertebral sympathetic chain. Its blockade is indicated in visceral pain syndromes and/or sympathetic pain syndromes of the perineal region. Several approaches to this block have been described, mainly through the anococcygeal or sacrococcygeal ligaments. We propose a modified approach to thermocoagulation of the Ganglion Impar, using a two-needle technique, the first one, placed through the sacrococcygeal ligament, the transsacrococcygeal needle, and the second one through a coccygeal disc, the transdiscal needle. The thermocoagulation technique that we employ uses a conventional radiofrequency application of 80 degrees C for 80 seconds through each needle. In this prospective study, 13 patients with chronic perineal, noncancer-related pain were followed for a maximum of 6 months. All of these patients underwent diagnostic Ganglion Impar block with local anesthetic prior to inducing neurodestruction with conventional radiofrequency application, as a positive result to the diagnostic local anesthetic block was a requisite for radiofrequency neurodestruction. We measured pain using a visual analog scale (VAS) before and after treatment. Statistical significance was assessed using the Mann-Whitney U-test and Wilcoxon range summation test. Initially the VAS was equal to or greater than 7. After therapy the VAS decreased by an average of 50% in the whole group. There were no adverse events. Our result show that this proposed modified approach to the block and use of radiofrequency for the Ganglion Impar is useful for the treatment of perineal noncancer-related pain.
Sanjay Thulkar - One of the best experts on this subject based on the ideXlab platform.
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early ultrasound guided neurolysis for pain management in gastrointestinal and pelvic malignancies an observational study in a tertiary care center of urban india
Pain Practice, 2012Co-Authors: Sandeep Khanna, Seema Mishra, Sushma Bhatnagar, S Roshni, Gaurav Nirwani Goyal, Shiv Pratap Singh Rana, Sanjay ThulkarAbstract:: Patients with advanced gastrointestinal and pelvic malignancies commonly present with pain of varying severity. In a majority of these patients, pain can be effectively managed using an integrated systemic pharmacological approach with oral morphine being the cornerstone of treatment. However, with escalating doses, intolerable side effects of oral morphine may lead to patient dissatisfaction. When oral pharmacotherapy fails to adequately address the issue of pain or leads to insufferable side effects, neurolytic blocks of the sympathetic axis are usually used for pain alleviation. As these blocks may reduce oral analgesic requirement, a reevaluation of their timing is merited. This article presents our hospital-based in-patient palliative care unit experience with early ultrasonography-guided neurolysis of celiac plexus, superior hypogastric plexus and Ganglion Impar. Of the 44 patients we studied, 20 underwent celiac plexus neurolysis, 18 superior hypogastric plexus neurolysis, and 6 Ganglion Impar neurolysis. Their pain was being managed with oral morphine before neurolysis, but only 11.4% patients required oral morphine for satisfactory pain control, 2 months after neurolysis. The mean Visual Analog Scale score before block placement was 5.64 ± 0.69 and fell to 2.25 ± 1.33 at 2 months post neurolysis (P < 0.001). We suggest that bedside ultrasonography-guided sympathetic axis neurolysis may be employed early in patients with incurable abdominal or pelvic cancer. Its use as a first-line intervention for achieving pain control with minimal complications warrants further consideration and investigation. ▪
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Ultrasonography reinvents the originally described technique for Ganglion Impar neurolysis in perianal cancer pain.
Anesthesia & Analgesia, 2008Co-Authors: Deepak Gupta, R. K. Jain, Seema Mishra, Surender Kumar, Sanjay Thulkar, Sushma BhatnagarAbstract:Visceral pain in the perineal area associated with malignancies may be effectively treated with neurolysis of the Ganglion Impar. Since the first description of the technique of accessing the Ganglion Impar through anococcygeal ligament, many techniques for Ganglion Impar block have been described. We present a patient diagnosed with carcinoma of the anal canal who was successfully given ultrasound-guided Ganglion Impar block using a Chiba needle inserted through the anococcygeal ligament. In summary, ultrasound-guided Ganglion Impar neurolysis is a fast, safe, and cost-effective method, which can be used as a first-line pain relief intervention for good quality of life in patients with perianal cancers.
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Pakter Curved Needle Set refines Ultrasound Guided Ganglion Impar Neurolysis
The Internet Journal of Anesthesiology, 2007Co-Authors: Deepak Gupta, Seema Mishra, Sanjay Thulkar, Narendra Babu, Himanshu Khurana, Sushma BhatnagarAbstract:IMPLICATIONS STATEMENT Technically Pakter Curved Needle Set can improve the success of the ultrasound guided Ganglion Impar neurolysis by more posterior projection of curved needle onto the anterior surface of coccyx.
Sahar Abdel-baky Mohamed - One of the best experts on this subject based on the ideXlab platform.
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superior hypogastric plexus combined with Ganglion Impar neurolytic blocks for pelvic and or perineal cancer pain relief
Pain Physician, 2015Co-Authors: Doaa Gomaa Ahmed, Mohamed F Mohamed, Sahar Abdel-baky MohamedAbstract:BACKGROUND The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The Ganglion Impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the Ganglion Impar neurolysis have been described in the literature. OBJECTIVES To assess the feasibility, safety, and efficacy of combining the block of the SHGP through the postero-median transdiscal approach with the GI block by the trans-sacro-coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or perineal malignancies or any cancer related causes. METHODS Fifteen patients who had cancer-related pelvic pain, perineal pain, or both received a combined SHGP neurolytic block through the postero-median transdiscal approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm needle and injection of 4 - 6 mL of 8% phenol in saline. Pain intensity (measured using a visual analogue scale) and oral morphine consumption pre- and post-procedure were measured. RESULTS All patients presented with cancer-related pelvic, perineal, or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to 2.40 ± 2.10 one week post-procedurally (P < 0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 98.00 ± 34.89 mg to 32.00 ± 28.48 mg after one week (P < 0.05). No complications or serious side effects were encountered during or after the block. LIMITATIONS This study is limited by its small sample size and non-randomized study. CONCLUSION A combined neurolytic SHGP block with GI block is an effective and safe technique for reducing pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach.
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Chemical neurolysis of the inferior hypogastric plexus for the treatment of cancer-related pelvic and perineal pain.
Pain research & management, 2013Co-Authors: Mohamad Farouk Mohamad, Sahar Abdel-baky Mohamed, Doaa Gomaa AhmedAbstract:BACKGROUND: Various interventions, including the superior hypogastric plexus block and Ganglion Impar block, are commonly used for the treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block (performed using a trans-sacral approach under fluoroscopy and using a local anesthetics/steroid combination) for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described in 2007. Neurolysis of the inferior hypogastric plexus may be useful for the treatment of pelvic and perineal pain caused by cancer.
