Title: A randomized controlled trial of ganglion impar block vs ganglion impar block with superior hypogastric plexus block for pain relief in patients of pelvic and perineal cancer
Authors: Dr Apoorva Gupta, Dr Sarita Singh, Dr Rajesh Raman, Dr Prem Raj Singh, Dr Manish Kumar Singh, Dr Rati Prabha, Dr Shashank Kumar
DOI: https://dx.doi.org/10.18535/jmscr/v8i3.104
Abstract
We compared the efficacy of Ganglion Impar (GI) block versus Superior Hypogastric Plexus (SHP) with GI block (both combined) for pain relief in patients of pelvic and perineal cancer. This prospective, randomized, double-blinded, controlled study was conducted on 50 patients, 18 to 70 years old with pelvic and perineal cancer pain with baseline VAS score>5.GI neurolysis with 3-5ml 70% alcohol in one group(group G) and GI along with SHP neurolysis with 10 ml 70% alcohol on either side was done in the other group(group S).VAS score, quality of life (QOL) score by Mcgill’s quality of life questionnaire, requirement of rescue analgesia post-procedure were assessed. The VAS score decreased in both the groups and was lower in group S than in group G, at all intervals except at baseline. QOL also improved in both the groups, the QOL scores being lower in S than G group at all intervals, except at 2 weeks follow up. Rescue analgesic requirement was similar in both the groups except at 2nd and 3rd months when morphine consumption was more in GROUP G. Concluded that GI block and GI with SHP block both provide drastic pain relief in pelvic and perineal cancer pain, pain relief being more when SHP is blocked along with GI. Quality of life is improved, and morphine requirement is reduced in both groups (more in group S).
Keywords: Ganglion Impar Block, Superior Hypogastric Plexus Block, Pelvic Cancer, Perineal Cancer, Quality of life questionnaire, visual analog scale.
References
- Caraceni A, Portenoy RK. An international survey of cancer pain characteristics and syndromes. IASP Task Force on Cancer Pain. Pain 1999; 82: 263-274.
- Manfredi PL, Gonzales GR, Sady R et al. Neuropathic pain in patients with cancer. J Palliat Care 2003; 19: 115-118.
- Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29: 4–20.
- Ahmed DG, MohamedMF, Mohamed SA. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief. Pain Physician 2015; 18:E49–E56
- Rigor BM. Pelvic cancer pain.JSurg Oncol.2000;75:280-300
- Gunduz OH, Sencan S, Kenis-Coskun O. Pain relief due to ranssacrococcygeal ganglion impar block in chronic coccygodynia: a pilot study. Pain Med. 2015;16:1278–1281.
- Toshniwal GR, Dureja GP, Prashanth SM. Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: A prospective observational study. Pain Physician 2007;10:661–6
- Wootton M. Morphine is not the only analgesic in palliative care: literature review. J Adv Nurs.2004; 45: 527-532.
- Wechsler RJ, Maurer PM, Halpern EJ, Frank Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. Radiology. 1995;196:103-6.
- Gamal G, Helaly M, Labib YM. Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 2006;22:544–547.
- Yeo SN, Chong JL. A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix. Annals of the Academy of Medicine, Singapore. 2001;30:632-5.