Advertisement

Sympathetic Nervous System Blocks for the Treatment of Cancer Pain

  • Nadya M. Dhanani
  • Wilson A. Almonte
  • Mitchell P. Engle
Chapter

Abstract

Disruption of the sympathetic nervous system with local anesthetics or neurolytic techniques has a robust history for the treatment of cancer-related pain. This chapter focuses on blocks of the sphenopalatine ganglion, stellate ganglion, thoracic sympathetic ganglion, celiac plexus, lumbar sympathetic ganglion, superior hypogastric plexus, and ganglion impar. Each section specifically discusses the anatomy, patient selection, procedural details, published treatment outcomes, and complications for each block. The goal of this chapter is to help the pain medicine practitioner rationally choose and perform sympathetic blocks for the treatment of cancer-related pain.

Keywords

Sphenopalatine ganglion block Stellate ganglion block Thoracic sympathetic ganglion block Celiac plexus block Splanchnic nerve block Lumbar sympathetic ganglion block Superior hypogastric plexus block Ganglion impar block Cancer pain Neurolysis 

References

  1. 1.
    Ackerknecht EH. The history of the discovery of the vegetative (autonomic) nervous system. Med Hist. 1974;18:1–8.CrossRefGoogle Scholar
  2. 2.
    Dargent M. Role of sympathetic nerve in cancerous pain; an inquiry on 300 cases. Br Med J. 1948;1:440–2.CrossRefGoogle Scholar
  3. 3.
    Gebhart GF, Bielefeldt K. Visceral pain. In: Basbaum AI, Masland RH, editors. The senses: a comprehensive reference. Amsterdam: Elsevier; 2008. p. 543–62.CrossRefGoogle Scholar
  4. 4.
    Martin LA, Hagen NA. Neuropathic pain in cancer patients: mechanisms, syndromes, and clinical controversies. J Pain Symptom Manag. 1997;14:99–117.CrossRefGoogle Scholar
  5. 5.
    Wilsey B, Teicheira D, Caneris OA, Fishman SM. A review of sympathetically maintained pain syndromes in the cancer pain population: the spectrum of ambiguous entities of RSD, CRPS, SMP and other pain states related to the sympathetic nervous system. Pain Pract. 2001;1:307–23.CrossRefGoogle Scholar
  6. 6.
    Sato J, Perl ER. Adrenergic excitation of cutaneous pain receptors induced by peripheral nerve injury. Science. 1991;251:1608–10.CrossRefGoogle Scholar
  7. 7.
    McLachlan EM, Janig W, Devor M, Michaelis M. Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature. 1993;363:543–6.CrossRefGoogle Scholar
  8. 8.
    Mantyh PW, Koltzenburg M, Mendell LM, Tive L, Shelton DL. Antagonism of nerve growth factor-TrkA signaling and the relief of pain. Anesthesiology. 2011;115:189–204.CrossRefGoogle Scholar
  9. 9.
    Day M. Neurolysis of the trigeminal and sphenopalatine ganglions. Pain Pract. 2001;1:171–82.CrossRefGoogle Scholar
  10. 10.
    Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, et al. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract. 2012;12:399–412.CrossRefGoogle Scholar
  11. 11.
    Leong MS, Gjolaj MP, Gaeta RR. Sphenopalatine ganglion block. New York: Springer. 2013.Google Scholar
  12. 12.
    Sanders M, Zuurmond WW. Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg. 1997;87:876–80.CrossRefGoogle Scholar
  13. 13.
    Narouze S, Kapural L, Casanova J, Mekhail N. Sphenopalatine ganglion radiofrequency ablation for the management of chronic cluster headache. Headache. 2009;49:571–7.CrossRefGoogle Scholar
  14. 14.
    Puig CM, Driscoll CL, Kern EB. Sluder’s sphenopalatine ganglion neuralgia – treatment with 88% phenol. Am J Rhinol. 1998;12:113–8.CrossRefGoogle Scholar
  15. 15.
    Bayer E, Racz GB, Miles D, Heavner J. Sphenopalatine ganglion pulsed radiofrequency treatment in 30 patients suffering from chronic face and head pain. Pain Pract. 2005;5:223–7.CrossRefGoogle Scholar
  16. 16.
    Prasanna A, Murthy PS. Sphenopalatine ganglion block and pain of cancer. J Pain Symptom Manag. 1993;8:125.CrossRefGoogle Scholar
  17. 17.
    Varghese BT, Cherian Koshy R, Sebastian P, Joseph E. Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer. Palliat Med. 2002;16:447–8.CrossRefGoogle Scholar
  18. 18.
    Syed MI, Shaikh A. Radiology of non-spinal pain procedures: a guide for the interventionalist. New York: Springer. 2013.Google Scholar
  19. 19.
    Yucel I, Demiraran Y, Ozturan K, Degirmenci E. Complex regional pain syndrome type I: efficacy of stellate ganglion blockade. J Orthop Traumatol. 2009;10:179–83.CrossRefGoogle Scholar
  20. 20.
    Ackerman WE, Zhang JM. Efficacy of stellate ganglion blockade for the management of type 1 complex regional pain syndrome. South Med J. 2006;99:1084–8.CrossRefGoogle Scholar
  21. 21.
    Kastler A, Aubry S, Sailley N, Michalakis D, Siliman G, Gory G, et al. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb. Eur Radiol. 2013;23:1316–22.CrossRefGoogle Scholar
  22. 22.
    Feigl GC, Rosmarin W, Stelzl A, Weninger B, Likar R. Comparison of different injectate volumes for stellate ganglion block: an anatomic and radiologic study. Reg Anesth Pain Med. 2007;32:203–8.PubMedGoogle Scholar
  23. 23.
    Arter OE, Racz GB. Pain management of the oncologic patient. Semin Surg Oncol. 1990;6:162–72.CrossRefGoogle Scholar
  24. 24.
    Higa K, Hori K, Harasawa I, Hirata K, Dan K. High thoracic epidural block relieves acute herpetic pain involving the trigeminal and cervical regions: comparison with effects of stellate ganglion block. Reg Anesth Pain Med. 1998;23:25–9.PubMedGoogle Scholar
  25. 25.
    Makharita MY, Amr YM, El-Bayoumy Y. Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia. Pain Physician. 2012;15:467–74.PubMedGoogle Scholar
  26. 26.
    Noguchi I, Hasegawa J, Kobayashi K, Takahashi H. Pain relief by stellate ganglion block in a case with trigeminal neuralgia caused by a cerebellopontine angle tumor. Anesth Prog. 2002;49:88–91.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Lipov EG, Joshi JR, Xie H, Slavin KV. Updated findings on the effects of stellate-ganglion block on hot flushes and night awakenings. Lancet Oncol. 2008;9:819–20.CrossRefGoogle Scholar
  28. 28.
    Lipov EG, Joshi JR, Sanders S, Wilcox K, Lipov S, Xie H, et al. Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncol. 2008;9:523–32.CrossRefGoogle Scholar
  29. 29.
    Abdi S, Zhou Y, Patel N, Saini B, Nelson J. A new and easy technique to block the stellate ganglion. Pain Physician. 2004;7:327–31.PubMedGoogle Scholar
  30. 30.
    Nabil Abbas D, Abd El Ghafar EM, Ibrahim WA, Omran AF. Fluoroscopic stellate ganglion block for postmastectomy pain: a comparison of the classic anterior approach and the oblique approach. Clin J Pain. 2011;27:207–13.CrossRefGoogle Scholar
  31. 31.
    Higa K, Hirata K, Hirota K, Nitahara K, Shono S. Retropharyngeal hematoma after stellate ganglion block: analysis of 27 patients reported in the literature. Anesthesiology. 2006;105:1238–45; discussion 5A-6A.CrossRefGoogle Scholar
  32. 32.
    Skaebuland C, Racz G. Indications and technique of thoracic(2) and thoracic(3) neurolysis. Curr Rev Pain. 1999;3:400–5.CrossRefGoogle Scholar
  33. 33.
    Yarzebski JL, Wilkinson HA. T2 and T3 sympathetic ganglia in the adult human: a cadaver and clinical-radiographic study and its clinical application. Neurosurgery. 1987;21:339–42.CrossRefGoogle Scholar
  34. 34.
    Yoo HS, Nahm FS, Lee PB, Lee CJ. Early thoracic sympathetic block improves the treatment effect for upper extremity neuropathic pain. Anesth Analg. 2011;113:605–9.PubMedGoogle Scholar
  35. 35.
    Agarwal-Kozlowski K, Lorke DE, Habermann CR, Schulte am Esch J, Beck H. Interventional management of intractable sympathetically mediated pain by computed tomography-guided catheter implantation for block and neuroablation of the thoracic sympathetic chain: technical approach and review of 322 procedures. Anaesthesia. 2011;66:699–708.CrossRefGoogle Scholar
  36. 36.
    Wilkinson HA. Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery. 1996;38:715–25.CrossRefGoogle Scholar
  37. 37.
    Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23:512–22.CrossRefGoogle Scholar
  38. 38.
    Kappis M. Erfahrungen mit local anasthesie bie bauchoperationen. Verh Dtsch Gesellsch Chir. 1914;43:87–9.Google Scholar
  39. 39.
    Lillemoe KD, Cameron JL, Kaufman HS, Yeo CJ, Pitt HA, Sauter PK. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann Surg. 1993;217:447–55. discussion 56-7CrossRefGoogle Scholar
  40. 40.
    Mercadante S. Celiac plexus block versus analgesics in pancreatic cancer pain. Pain. 1993;52:187–92.CrossRefGoogle Scholar
  41. 41.
    Kawamata M, Ishitani K, Ishikawa K, Sasaki H, Ota K, Omote K, et al. Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain. Pain. 1996;64:597–602.CrossRefGoogle Scholar
  42. 42.
    Polati E, Finco G, Gottin L, Bassi C, Pederzoli P, Ischia S. Prospective randomized double-blind trial of neurolytic coeliac plexus block in patients with pancreatic cancer. Br J Surg. 1998;85:199–201.CrossRefGoogle Scholar
  43. 43.
    Zhang CL, Zhang TJ, Guo YN, Yang LQ, He MW, Shi JZ, et al. Effect of neurolytic celiac plexus block guided by computerized tomography on pancreatic cancer pain. Dig Dis Sci. 2008;53:856–60.CrossRefGoogle Scholar
  44. 44.
    Wong GY, Schroeder DR, Carns PE, Wilson JL, Martin DP, Kinney MO, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA. 2004;291:1092–9.CrossRefGoogle Scholar
  45. 45.
    Wyse JM, Carone M, Paquin SC, Usatii M, Sahai AV. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol. 2011;29:3541–6.CrossRefGoogle Scholar
  46. 46.
    Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev. 2011;3:CD007519.Google Scholar
  47. 47.
    McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, Cohen SP. The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract. 2013;13:89–95.CrossRefGoogle Scholar
  48. 48.
    De Cicco M, Matovic M, Balestreri L, Fracasso A, Morassut S, Testa V. Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions? Anesthesiology. 1997;87:1301–8.CrossRefGoogle Scholar
  49. 49.
    De Cicco M, Matovic M, Bortolussi R, Coran F, Fantin D, Fabiani F, et al. Celiac plexus block: injectate spread and pain relief in patients with regional anatomic distortions. Anesthesiology. 2001;94:561–5.CrossRefGoogle Scholar
  50. 50.
    Brown DL, Bulley CK, Quiel EL. Neurolytic celiac plexus block for pancreatic cancer pain. Anesth Analg. 1987;66:869–73.PubMedGoogle Scholar
  51. 51.
    Brown DL, Moore DC. The use of neurolytic celiac plexus block for pancreatic cancer: anatomy and technique. J Pain Symptom Manag. 1988;3:206–9.CrossRefGoogle Scholar
  52. 52.
    Brown DL. A retrospective analysis of neurolytic celiac plexus block for nonpancreatic intra-abdominal cancer pain. Reg Anesth. 1989;14:63–5.PubMedGoogle Scholar
  53. 53.
    Kaplan R, Schiff-Keren B, Alt E. Aortic dissection as a complication of celiac plexus block. Anesthesiology. 1995;83:632–5.CrossRefGoogle Scholar
  54. 54.
    Pello S, Miller A, Ku T, Wang D. Hemorrhagic gastritis and duodenitis following celiac plexus neurolysis. Pain Physician. 2009;12:1001–3.PubMedGoogle Scholar
  55. 55.
    Davies DD. Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med. 1993;86:264–6.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Rathmell JP. Atlas of image-guided intervention in regional anesthesia and pain medicine: Wolters Kluwer Health; 2012.Google Scholar
  57. 57.
    Gulati A, Khelemsky Y, Loh J, Puttanniah V, Malhotra V, Cubert K. The use of lumbar sympathetic blockade at L4 for management of malignancy-related bladder spasms. Pain Physician. 2011;14:305–10.Google Scholar
  58. 58.
    Cameron HU, Park YS, Krestow M. Reflex sympathetic dystrophy following total knee replacement. Contemp Orthop. 1994;29:279–81.PubMedGoogle Scholar
  59. 59.
    Rocco AG. Radiofrequency lumbar sympatholysis. The evolution of a technique for managing sympathetically maintained pain. Reg Anesth. 1995;20:3–12.PubMedGoogle Scholar
  60. 60.
    Manjunath PS, Jayalakshmi TS, Dureja GP, Prevost AT. Management of lower limb complex regional pain syndrome type 1: an evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis – a pilot study. Anesth Analg. 2008;106:647–9. table of contentsCrossRefGoogle Scholar
  61. 61.
    Carroll I, Clark JD, Mackey S. Sympathetic block with botulinum toxin to treat complex regional pain syndrome. Ann Neurol. 2009;65:348–51.CrossRefGoogle Scholar
  62. 62.
    Pennekamp W, Krumova EK, Feigl GP, Frombach E, Nicolas V, Schwarzer A, et al. Permanent lesion of the lateral femoral cutaneous nerve after low-volume ethanol 96% application on the lumbar sympathetic chain. Pain Physician. 2013;16:391–7.PubMedGoogle Scholar
  63. 63.
    Plancarte R, Amescua C, Patt RB, Aldrete JA. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology. 1990;73:236–9.CrossRefGoogle Scholar
  64. 64.
    de Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54:145–51.CrossRefGoogle Scholar
  65. 65.
    Plancarte R, de Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22:562–8.PubMedGoogle Scholar
  66. 66.
    Kroll CE, Schartz B, Gonzalez-Fernandez M, Gordon AH, Babade M, Erdek MA, et al. Factors associated with outcome after superior hypogastric plexus neurolysis in cancer patients. Clin J Pain. 2014;30:55–62.CrossRefGoogle Scholar
  67. 67.
    Erdine S. Transdiscal approach for hypogastric plexus block. Reg Anesth Pain Med. 2003;28:304–8.PubMedGoogle Scholar
  68. 68.
    Gamal G, Helaly M, Labib YM. Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 2006;22:544–7.CrossRefGoogle Scholar
  69. 69.
    Nabil D, Eissa AA. Evaluation of posteromedial transdiscal superior hypogastric block after failure of the classic approach. Clin J Pain. 2010;26:694–7.PubMedGoogle Scholar
  70. 70.
    Plancarte R, Amescua C, Patt RB. Presacral blockade of the ganglion impar (ganglion of Walther). Anesthesiology. 1990. (Abstract;73:A751.Google Scholar
  71. 71.
    Eker HE, Cok OY, Kocum A, Acil M, Turkoz A. Transsacrococcygeal approach to ganglion impar for pelvic cancer pain: a report of 3 cases. Reg Anesth Pain Med. 2008;33:381–2.Google Scholar
  72. 72.
    Bhatnagar S, Khanna S, Roshni S, Goyal GN, Mishra S, Rana SP, et al. Early ultrasound-guided neurolysis for pain management in gastrointestinal and pelvic malignancies: an observational study in a tertiary care center of urban India. Pain Pract. 2012;12:23–32.CrossRefGoogle Scholar
  73. 73.
    Swofford JB, Ratzman DM. A transarticular approach to blockade of the ganglion impar (ganglion of walther). Reg Anesth Pain Med. 1998;23:25.CrossRefGoogle Scholar
  74. 74.
    Reig E, Abejon D, del Pozo C, Insausti J, Contreras R. Thermocoagulation of the ganglion impar or ganglion of Walther: description of a modified approach. Preliminary results in chronic, nononcological pain. Pain Pract. 2005;5:103–10.CrossRefGoogle Scholar
  75. 75.
    Griffin R, Fink E, Brenner GJ. Bonica’s management of pain. In: Fishman S, Ballantyne J, Rathmell JP, Bonica JJ, editors. Baltimore: Lippincott, Williams & Wilkins; 2010. p. 98–119.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nadya M. Dhanani
    • 1
  • Wilson A. Almonte
    • 2
  • Mitchell P. Engle
    • 3
  1. 1.Memorial Hermann Hospital/Mischer Neuroscience Institute, Department of Pain Management/NeurosurgeryHoustonUSA
  2. 2.Victoria Pain and Rehabilitation CenterVictoriaUSA
  3. 3.Institute of Precision Pain MedicineCorpus ChristiUSA

Personalised recommendations