Factors Associated With Outcome After Superior Hypogastric Plexus Neurolysis in Cancer Patients

Departments of *Anesthesiology & Critical Care Medicine †Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore §Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD ‡Department of Pain Medicine, Cleveland Clinic Foundation, Cleveland, OH.
The Clinical journal of pain (Impact Factor: 2.7). 02/2013; 30(1). DOI: 10.1097/AJP.0b013e3182869d68
Source: PubMed

ABSTRACT OBJECTIVE:: Superior hypogastric plexus neurolysis (SHP-N) has been shown in uncontrolled studies to provide intermediate-term benefit in a majority of patients with pain secondary to genitourinary, gynecologic, and colorectal cancers. The purpose of this is to determine factors associated with treatment outcome. MATERIALS AND METHODS:: Patients who underwent SHP-N after a positive prognostic block were identified based on diagnostic classification and procedural codes from databases at 2 large teaching hospitals. A host of demographic, clinical, and treatment factors were examined for their association with treatment success, which was defined as ≥50% pain relief lasting ≥1 month. RESULTS:: A total of 53.1% of 32 patients with sufficient medical records for analysis experienced a positive outcome. Those with a positive outcome were older (mean age 59.6 y, SD 13.1 vs. 47.8, SD 15.6; P=0.03), less likely to have pelvic pain (36.8% success rate, P=0.04), and more likely to have bladder cancer (88.9% success rate; P=0.01) than those with a negative outcome. In stratified analysis, female were more likely to have positive outcome if they did not have pelvic pain compared to those that did (P=0.008). This difference was not significant for males. DISCUSSION:: Selecting patients based on demographic and clinical variables may improve treatment outcomes for SHP-N. Larger, prospective studies are needed to confirm our results and better refine selection criteria better.

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