Mishra, S., Bhatnagar, S., Rana, S.P., Khurana, D., & Thulkar, S. (2013). Efficacy of the anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain in advanced gynecological cancer patients. Pain Medicine, 14, 837–842.

To evaluate the effect of anterior ultrasound-guided superior hypogastric plexus neurolysis in patients with gynecologic cancer with pelvic cancer pain

Patients were randomly divided into two groups. Group 1 received oral morphine for pain control, and group 2 had ultrasonography-guided superior hypogastric plexus neurolysis (SHPN). Oral morphine was given to both groups as rescue analgesia. The pain, functional capacity, global satisfaction score, and adverse effects were recorded.

• N = 50  
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Advanced gynecologic malignancy (stage III and IV), no planned curative intervention or chronic pelvic pain, visual analog scale (VAS) score greater than 7
• EXCLUSION CRITERIA: Unstable cardiovascular, respiratory, hepatic, or hematologic disease; psychological disorder; lower limb neurologic disorder; drug abuse

• SITE: Single site   
• SETTING TYPE: Inpatient   
• LOCATION: Rotary Cancer Hospital, New Delhi, India

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care, palliative care

• Randomized, controlled trial

• VAS
• Eastern Cooperative Oncology Group (ECOG) status
• Global pain relief score
• Global satisfaction score

No difference was seen between the two groups when comparing age, height, and wight (P > 0.05). Both groups showed a significant decrease in VAS pain sores at one week, one month, two months, and three months, and from baseline at each visit (P < 0.05). At three months, no significant difference was seen in VAS scores. No statistical difference was seen in baseline morphine consumption. Consumption declined from baseline in group 2 at the first week, but consumption increased at the rest of the time points. At the first week and month, rescue doses of morphine differed but not significantly for the last two visits. At week one, ECOG status was significantly better for group 2 (p = 0.002), and global pain was better at one month (p = 0.008), but by the end of the study, no statistical difference was seen. The global satisfaction score was better at dthe first week (p = 0.00) and first month (p = 0.04). Less adverse effects occurred in group 2 than group 1, but the difference was not statistically significant.

Ultrasonography-guided SHPN may be a potential intervention for patients with gynecologic cancer experiencing pelvic pain. This may be an option for those who cannot tolerate opioids or are experiencing adverse effects from long-term use of opioids. Although this intervention requires prep and fasting and is associated with its own adverse effects and risk, this may be an option for intervention. This study does not appear strong enough to replace opiate as the standard but rather supports the intervention as an adjuvant treatment because a portion of patients with cancer may be resistant to traditional therapies.

• Small sample (less than 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Findings not generalizable
• Other limitations/explanation: The intervention requires a certain amount of expertise to perform, can be associated with several adverse effects, is invasive, and requires bowel prep and the patient to fast for eight hours.

Nurses need to be aware of this potential intervention and management of adverse events in practice. Education would be required to manage adverse effects and side effects of this intervention.