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Sanjay Thulkar - One of the best experts on this subject based on the ideXlab platform.
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efficacy of the anterior ultrasound guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients
Pain Medicine, 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P < 0.05) greater. The daily morphine consumption in Group II decreased throughout the study, and more patients in Group II improved in their functional capacity, although it was statistically insignificant. It was observed that global satisfaction scores were better in Group II during the initial first (P = 0.001) week and 1 month (P = 0.04) compared with Group I. Conclusion The anterior USG-guided Superior Hypogastric Plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided Superior Hypogastric block.
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Efficacy of the anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients.
Pain medicine (Malden Mass.), 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P
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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: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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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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 : the official journal of World Institute of Pain, 2011Co-Authors: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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
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Anterior Ultrasound-Guided Superior Hypogastric Plexus Neurolysis in Pelvic Cancer Pain:
Anaesthesia and intensive care, 2008Co-Authors: Seema Mishra, Sushma Bhatnagar, Deepak Gupta, Sanjay ThulkarAbstract:The Hypogastric Plexus block is classically performed by a posterior approach, but there are recent reports of a computed tomography-guided anterior approach for patients who have difficult access to the Hypogastric Plexus by the posterior approach. We present two patients who were successfully given ultrasound-guided Superior Hypogastric Plexus block by an anterior approach. The anterior ultrasound-guided Superior Hypogastric Plexus neurolysis technique is simple to perform. We believe this block can be useful in cancer patients who are having difficulty in lying prone, because it is a bedside procedure performed in the supine position and it is less time-consuming. It also avoids the radiation exposure involved with a computed tomography-guided anterior approach.
Sushma Bhatnagar - One of the best experts on this subject based on the ideXlab platform.
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efficacy of the anterior ultrasound guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients
Pain Medicine, 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P < 0.05) greater. The daily morphine consumption in Group II decreased throughout the study, and more patients in Group II improved in their functional capacity, although it was statistically insignificant. It was observed that global satisfaction scores were better in Group II during the initial first (P = 0.001) week and 1 month (P = 0.04) compared with Group I. Conclusion The anterior USG-guided Superior Hypogastric Plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided Superior Hypogastric block.
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Efficacy of the anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients.
Pain medicine (Malden Mass.), 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P
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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: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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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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 : the official journal of World Institute of Pain, 2011Co-Authors: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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
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Anterior Ultrasound-Guided Superior Hypogastric Plexus Neurolysis in Pelvic Cancer Pain:
Anaesthesia and intensive care, 2008Co-Authors: Seema Mishra, Sushma Bhatnagar, Deepak Gupta, Sanjay ThulkarAbstract:The Hypogastric Plexus block is classically performed by a posterior approach, but there are recent reports of a computed tomography-guided anterior approach for patients who have difficult access to the Hypogastric Plexus by the posterior approach. We present two patients who were successfully given ultrasound-guided Superior Hypogastric Plexus block by an anterior approach. The anterior ultrasound-guided Superior Hypogastric Plexus neurolysis technique is simple to perform. We believe this block can be useful in cancer patients who are having difficulty in lying prone, because it is a bedside procedure performed in the supine position and it is less time-consuming. It also avoids the radiation exposure involved with a computed tomography-guided anterior approach.
Seema Mishra - One of the best experts on this subject based on the ideXlab platform.
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efficacy of the anterior ultrasound guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients
Pain Medicine, 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P < 0.05) greater. The daily morphine consumption in Group II decreased throughout the study, and more patients in Group II improved in their functional capacity, although it was statistically insignificant. It was observed that global satisfaction scores were better in Group II during the initial first (P = 0.001) week and 1 month (P = 0.04) compared with Group I. Conclusion The anterior USG-guided Superior Hypogastric Plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided Superior Hypogastric block.
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Efficacy of the anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients.
Pain medicine (Malden Mass.), 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P
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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: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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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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 : the official journal of World Institute of Pain, 2011Co-Authors: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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
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Anterior Ultrasound-Guided Superior Hypogastric Plexus Neurolysis in Pelvic Cancer Pain:
Anaesthesia and intensive care, 2008Co-Authors: Seema Mishra, Sushma Bhatnagar, Deepak Gupta, Sanjay ThulkarAbstract:The Hypogastric Plexus block is classically performed by a posterior approach, but there are recent reports of a computed tomography-guided anterior approach for patients who have difficult access to the Hypogastric Plexus by the posterior approach. We present two patients who were successfully given ultrasound-guided Superior Hypogastric Plexus block by an anterior approach. The anterior ultrasound-guided Superior Hypogastric Plexus neurolysis technique is simple to perform. We believe this block can be useful in cancer patients who are having difficulty in lying prone, because it is a bedside procedure performed in the supine position and it is less time-consuming. It also avoids the radiation exposure involved with a computed tomography-guided anterior approach.
Shiv Pratap Singh Rana - One of the best experts on this subject based on the ideXlab platform.
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efficacy of the anterior ultrasound guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients
Pain Medicine, 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P < 0.05) greater. The daily morphine consumption in Group II decreased throughout the study, and more patients in Group II improved in their functional capacity, although it was statistically insignificant. It was observed that global satisfaction scores were better in Group II during the initial first (P = 0.001) week and 1 month (P = 0.04) compared with Group I. Conclusion The anterior USG-guided Superior Hypogastric Plexus neurolysis is a useful technique in relieving pelvic pain in gynecological malignancies. However, it requires expertise to perform the block. It also avoids the radiation exposure involved with computed tomography-guided and fluoroscopy-guided Superior Hypogastric block.
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Efficacy of the anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients.
Pain medicine (Malden Mass.), 2013Co-Authors: Seema Mishra, Sushma Bhatnagar, Shiv Pratap Singh Rana, Deepa Khurana, Sanjay ThulkarAbstract:Background and Aims Pelvic cancer pain is a chronic pain related to the involvement of viscera, neural, and pelvic muscular. The study was carried out to evaluate the efficacy of anterior ultrasound-guided Superior Hypogastric Plexus neurolysis in pelvic cancer pain in gynecological cancer patients. Material & Methods The study was conducted after approval of our Institutional Ethics Committee. A total of 50 patients diagnosed with the advanced stage of a gynecological malignancy with severe pelvic pain were enrolled and randomly divided in two groups; in Group I, patients were given oral morphine, while in Group II, patients underwent anterior ultrasonography (USG)-guided Superior Hypogastric neurolysis. Oral morphine was given as rescue analgesia in both the groups. The parameters recorded were pain, functional capacity, global satisfaction score, and adverse effects. Results There was a significant decrease in visual analog scale (VAS) score in the both groups, but the decline in VAS scores from baseline in Group II was significantly (P
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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: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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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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 : the official journal of World Institute of Pain, 2011Co-Authors: Sushma Bhatnagar, Sandeep Khanna, S Roshni, Gaurav Nirwani Goyal, Seema Mishra, 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
Francis Sahngun Nahm - One of the best experts on this subject based on the ideXlab platform.
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Unilateral, single needle approach using an epidural catheter for bilateral Superior Hypogastric Plexus block.
The Korean journal of pain, 2012Co-Authors: Ji Seok Baik, Eun Joo Choi, Pyung Bok Lee, Francis Sahngun NahmAbstract:The Superior Hypogastric Plexus block (SHPB) is used for treating pelvic pain, especially in patients with gynecological malignancies. Various approaches to this procedure have been reported due to the anatomic obstacles of a high iliac crest or large transverse process of the 5th lumbar vertebra. Here, we report a new technique of Superior Hypogastric Plexus block using a unilateral single-needle approach to block the bilateral Superior Hypogastric Plexus with a Tuohy needle and epidural catheter. We have confidence that this new technique can be another option in performing the SHPB when the conventional bilateral approach is difficult to perform.
