• The Korean Journal of Pain
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• v.18 no.1
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• pp.74-77
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• 2005

A neurolytic celiac plexus block produces long-lasting pain relief in upper abdominal cancer patients. Unwanted side effects such as local pain, hypotension, and diarrhea are common but the durations of these side effects are usually transient. Chronic diarrhea induced by a neurolytic celiac plexus block is rarely reported and is considered to be an autonomic neuropathy due to sympathetic denervation. A 73-year-old Klatskin tumor patient developed chronic diarrhea after a neurolytic celiac plexus block and the diarrhea was sustained for 3 months despite the use of conventional antidiarrheal treatments. We report a case of chronic diarrhea that was induced by a neurolytic celiac plexus block.

• The Korean Journal of Pain
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• v.4 no.1
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• pp.31-36
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• 1991

Intraspinal alcohol or phenol administration has been used for the treatment of intractable pain due to terminal cancer. It has been alleged to produce good pain relief with minimal complication if performed carefully. We analysed 35 patients who received epidural or subarachnoid neurolytic block out of 83 patients with malignancy who were referrecl to our pain clinic. Most of the patients needed additional treatment modalities including epidural catheterization or systemic narcotic administration. The incidence of complication was high, especially when the neurolytic agents were administered in the lumbar region. This suggest that intraspinal neurolytic block is unreliable and unsafe, although it may temporarily reduce the analgesic requirement.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.177-180
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• 1988

Transsacral neurolytic block with 2.5ml of phenol in glycerine or bupivacaine was performed in 6 patients with malignant diseases and a patient with sphincter spasm of bladder due to spinal cord injury. Pain relief was satisfactory in all patints except one patient with very low pain threshold. In one patient, second transsacral neurolytic block alone was not sufficient because of widespread pain along distant metastasis of the malignant disease, although the first block was satisfactory. The complications include transient motor weakness(4), voiding difficulty(1), subarachnoid puncture(1), and epidural venous puncture(1), but they were all spontaneously recovered within a sbort period of time and did not give any limitation to the block.

• The Korean Journal of Pain
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• v.31 no.1
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• pp.50-53
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• 2018

We present a patient with metastatic colon carcinoma who developed paraplegia following a neurolytic splanchnic block. A 41-year old man with metastatic adenocarcinoma of the colon received a splanchnic neurolytic block using alcohol because of severe abdominal pain. Bilateral motor weakness and a sensorial deficit in both legs developed after the procedure. Diffusion magnetic resonance imaging revealed spinal cord ischemia between T8 and L1. The motor and sensorial deficits were almost completely resolved at the end of the third month. We think that anterior spinal artery syndrome due to reversible spasms of the lumbar radicular arteries using alcohol have resulted in transient paraplegia. The retrograde spread of alcohol to neural structures may have also contributed.

• The Korean Journal of Pain
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• v.2 no.2
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• pp.181-188
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• 1989

Neurolytic splanchnic nerve block is an effective method for the relief of pain of upper abdominal cancer. Nine cases of intractable upper abdominal cancer pain were treated by splanchnic nerve block with absolute alcohol (25 ml) at the pain clinic of Kangdong Sacred Heart Hospital, Hallym University, during a 19 month period from March, 1988 to September, 1989. The group included six patients with stomach cancer, two patients with pancreatic cancer, and one patient with hepatobiliary cancer. We used fluoroscopy in all cases of alcohol spianchnic nerve block to determine both, the position of the needle tip, and the spread of the neurolytic solution. Of the 9 patients, 6 patients had excellent pain relief, and 3 patients who had combined upper abdominal and lower back pain had relieved upper abdominal pain only, but remaining lower back pain. Of the 9 patients', 5 patients had excellent pain relief through the patients remaining life (1-2 months) in which follow up was possible.

• The Korean Journal of Pain
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• v.13 no.2
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• pp.202-207
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• 2000

Background: Superior hypogastric plexus block has been advocated as a useful technique for the treatment of cancer related pelvic pain. The aim of this study was to evaluate the effect of neurolytic trans-intervertebrodiscal superior hypogastric plexus block for pelvic cancer pain. Methods: Twenty-eight patients with gynecologic, colorectal or genitourinary cancer who suffered intractable pain were studied. We performed superior hypogastric plexus block by trans-intervertebrodiscal approach at L5/S1 level under the C-arm fluoroscopic guide unilaterally or bilaterally. Ten ml of 100% dehydrated alcohol was injected through each needle. We evaluated the change of visual analog pain score (VAS; 0~100 mm) and daily dose of oral morphine sulphate at the time of pre-block and 7 days after the block. Results: Fourteen patients (50%) had satisfactory pain relief (VAS<30) while five patients (18%) had moderate pain control (VAS 30~60). The remaining nine patients (32%) had mild or little pain relief (VAS>60) and their daily oral morphine doses were above 160 mg. Additional pain control method may be needed for those patients who received high dose of opioid before neurolytic block. Conclusions: We conclude trans-intervertebrodiscal neurolytic superior hypogastric plexus block was effective in relieving pelvic cancer pain. Neurolytic block, earlier stage, may provide better effects for more comfortable life at the end stage for cancer patients.

• The Korean Journal of Pain
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• v.23 no.4
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• pp.274-277
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• 2010

Abdominal pain associated with chronic pancreatitis is often difficult to control with analgesics and can be severely debilitating with significant impairment of quality of life. In these patients, neurolytic celiac plexus block (NCPB) is an effective treatment option with a low complication rate. However, there is a risk of ejaculatory failure after NCPB, which may be a problem in patients with a long life expectancy. We report a case of ejaculatory failure after unilateral NCPB in a patient with chronic pancreatitis.

• Journal of Hospice and Palliative Care
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• v.11 no.1
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• pp.51-54
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• 2008

Qualify of life is the main consideration in pain management and palliative care for patients with advanced cancer. Cancer pain is primarily relieved with pharmacological therapy including aretaminophen, nonsteroidal anti-inflammatory drugs, adjuvant analgesics, and opioids. In addition to pharmacological therapy, the neurolytic celiac plexus block is claimed to be an effective approach in management of advanced pancreatic cancer pain. We report our patient who has been treated for advanced cancer pain with multiple neurolytic blocks. The clinical result suggests that combined neurolytic blocks improved the quality of life of patient who had advanced ranter pain by reducing both the intensity of pain and opioid consumption, without serious complications.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.199-204
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• 1994

The purpose of this study is to evaluate the feasibility, advantages/disadvantages of patient-controlled sedation (PCS) compared to anesthesiologist-controlled sedation (ACS) during neurolytic pain block and regional anesthesia. Forty patients were divided randomly into two groups of 20 patients each. Group 1(ACS) received 0.01 $mg{\cdot}kg^{-1}$ intravenous midazolam and 0.5 ${\mu}g{\cdot}kg^{-1}$ fentanyl intravenously by anesthesiologist just before, 30, and 60 minutes after the procedure to acheive sedation; Group 2 (PCS) patients self-administered a mixture of midazolam (0.4 mg) and fentanyl ($20{\mu}g$) using a syringe type infusion pump (Terumo, Japan) to acheive sedation. Considering the dermographics of patients, the types and durations of procedure performed, the level of average sedation the comfort level were similar in both groups. But the doses of midazolam and fentanyl administerd in group 2 were smaller than those in group 1 (p<0.01). Patients in PCS group showed their level of sedation more proper than did those in ACS group. However, patients in ACS group rated their level of comfort higher than did those in PCS group. The findings of this study indicate that PCS using a combination of midazolam and fentanyl is a fafe and effective technique. More studies are, however, needed to determinc the best choice of drug(s), doses, lock-out intervals, and possible use of continuous infusion with patient-controlled sedation.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.162-169
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• 1994

Blockade of cervicothoracic sympathetic ganglion (stellate ganglion controls pain on face, head, neck, shoulder, upper limbs, and upper chest, including their viscera and sympathetically maintained pain. This procedure also increases blood flow to the above areas and relieves hyperreactivity of sympathetic nervous system. Clinically, repeated stellate ganglion blocks with local anesthetic agent may become difficult with complications such as accidental intravascular or subdural injection, recurrent laryngeal nerve or bracheal plexus paralysis, pneumothorax and edema on injection site. Therefore, at times long-term cervicothoracic ganglion block with neurolytics is necessitated but its applications are prohibited by the critical structures surrounding ganglion. There are also few reports of neurolytic stellate ganglion block. This study was performed to observe the complications, gross changes of surrounding structures, and microscopic findings of ganglion cells after neurolytic block and to certify the possibility of clinical use of neruolytic stellate ganglion block. The unilateral superior cervical sympathetic ganglion of rabbit was blocked with absolute ethyl alcohol 0.4 ml at the level of cricoid cartilage. Normal ganglion was used as a control and 5 animals were sacrificed at each intervals of 7, 15 and 50 days after block. The results were as follows; 1) All experimental animals showed no specific changes of behavior, motor function. No necrotic tissues were present in the block area during the observation period. There were some gross scar tissues along the fascia of muscles surrounding the needle injection site, but gross atrophy of muscles or injured major vessels were not found. 2) Microscopically, structures of normal ganglion of rabbit were very similar to those of humans. Seven days after absolute ethyl achohol injection there were marked edema of ganglion cells and nuclei with irregular nuclear membrane. Some of the ganglion cells lost their nuclei and showed degenerative changes. Fifteen days after block, cell edema were decreased and loss of the Nissl's body was prominant. The ganglion cell structures looked close to normal but the cytoplasm and nucleus were generally contracted 50 days after block. These results suggest absolute ethyl alcohol injection on cervical sympathetic ganglion with above method mainly blocks pre- and post-synaptic fibers and the long-term neurolytic blockade of this ganglion may be possible in rabbits.