O Bloqueio do plexo hipogástrico superior é eficaz no tratamento de dor pélvica crônica?

André P Schmidt; Sérgio R G Schmidt; Sady M Ribeiro

doi:10.1590/S0034-70942005000600011

Review Article

O Bloqueio do plexo hipogástrico superior é eficaz no tratamento de dor pélvica crônica?

Is superior hypogastric plexus block effective for treatment of chronic pelvic pain?

André P Schmidt; Sérgio R G Schmidt; Sady M Ribeiro

http://dx.doi.org/10.1590/S0034-70942005000600011 Braz J Anesthesiol, vol.55, n6, p.669-679, 2005

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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo hipogástrico tem sido apresentado como uma alternativa segura e eficaz no tratamento de pacientes portadores de dor pélvica crônica. Os estudos publicados e disponíveis no MedLine, abordando este tema, foram incluídos e analisados nesta revisão. CONTEÚDO: Alguns estudos documentaram a eficácia do bloqueio do plexo hipogástrico superior em reduzir a intensidade da dor e o consumo de opióides, principalmente em pacientes com câncer. No entanto, os estudos apresentam falhas em seus métodos ou desenhos. CONCLUSÕES: Novos estudos prospectivos melhor conduzidos ainda são necessários para ratificar a efetividade do bloqueio do plexo hipogástrico no alívio de condições dolorosas pélvicas. Esses estudos devem possuir critérios de inclusão mais rigorosos, seguimento mais prolongado, avaliação de outros sintomas e da qualidade de vida antes e após o procedimento. O bloqueio do plexo hipogástrico superior deve ser recomendado como uma alternativa e não como terapêutica principal.

Palavras-chave

DOR, Crônica, DOR, Crônica, METODOLOGIA CIENTÍFICA, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Hypograstric plexus block has been considered a safe and effective alternative for treat patients with chronic pelvic pain. Published studies available at MedLine on the subject were included and evaluated in this review. CONTENTS: Some studies have documented superior hypogastric plexus block effectiveness in relieving pain and decreasing opioid consumption, mainly in cancer patients. However, studies had failures in method or design. CONCLUSIONS: New prospective and better-designed studies are still needed to confirm the effectiveness of hypogastric plexus block in relieving pelvic pain. These studies shall have stricter inclusion criteria, longer follow-up, and evaluation of other symptoms and quality of life before and after the procedure. Superior hypogastric plexus block should be recommended as alternative and not as primary therapy.

Keywords

ANESTHETIC TECHNIQUES, Regional, PAIN, Chronic, PAIN, Chronic, SCIENTIFIC METHODOLOGY, SCIENTIFIC METHODOLOGY

Referências

Bonica JJ. The management of pain of malignant disease with nerve blocks. Anesthesiology. 1954;15:134-135.

Bonica JJ. Autonomic innervation of the viscera in relation to nerve block. Anesthesiology. 1968;29:793-813.

Rapkin AJ. Neuroanatomy, neurophysiology, and neuro- pharmacology of pelvic pain. Clin Obstet Gynecol. 1990;33:119-129.

De Leon-Casasola OA, Kent E, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain. 1993;54:145-151.

Lee RB, Stone K, Magelssen D. Presacral neurectomy for chronic pelvic pain. Obstet Gynecol. 1986;68:517-521.

Tjaden B, Schlaff WD, Kimball A. The efficacy of presacral neurectomy for the relief of midline dysmenorrhea. Obstet Gynecol. 1990;76:89-91.

Candiani GB, Fedele L, Vercellini P. Presacral neurectomy for the treatment of pelvic pain associated with endometriosis: a controlled study. Am J Obstet Gynecol. 1992;167:100-103.

Wechsler RJ, Maurer PM, Halpern EJ. Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. Radiology. 1995;196:103-106.

Stevens DS, Balatbat GR, Lee FM. Coaxial imaging technique for superior hypogastric plexus block. Reg Anesth Pain Med. 2000;25:643-647.

Kanazi GE, Perkins FM, Thakur R. New technique for superior hypogastric plexus block. Reg Anesth Pain Med. 1999;24:473-476.

Steege JF. Superior hypogastric block during micro- laparoscopic pain mapping. J Am Assoc Gynecol Laparosc. 1998;5:265-267.

Rosenberg SK, Tewari R, Boswell MV. - Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of prostate. Reg Anesth Pain Med. 1998;23:618-620.

Plancarte R, Amescua C, Patt RB. Superior hypogastric plexus for pelvic cancer pain. Anesthesiology. 1990;73:236-239.

Zondervan KT, Yudkin PL, Vessey MP. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol. 1999;106:1149-1155.

Mathias SD, Kuppermann M, Liberman RF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. 1996;87:321-327.

Plancarte R, de Leon-Casasola OA, El-Helaly M. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth. 1997;22:562-568.

Portenoy RK. Cancer pain: Epidemiology and syndromes. Cancer. 1989;63(^s11):2298-2307.

Levy MH. Pharmacologic treatment of cancer pain. N Engl J Med. 1996;335:1124-1132.

Patt RB, Reddy SK, Black RG. Neural blockade for abdominopelvic pain of oncologic origin. Int Anesthesiol Clin. 1998;36:87-104.

De Leon-Casasola OA. Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain. Cancer Control. 2000;7:142-148.

Lee RB, Stone , Magelssen D. Presacral neurectomy for chronic pelvic pain. Obstet Gynecol. 1986;68:517-521.

Mercadante S, Fulfaro F, Casuccio A. Pain mechanisms involved and outcome in advanced cancer patients with possible indications for celiac plexus block and superior hypogastric plexus block. Tumori. 2002;88:243-245.

de Oliveira R, dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain. 2004;110:400-408.

De Leon-Casasola OA, Plancarte-Sanchez R, Patt RB. Superior hypogastric plexus block using a single needle and computed tomography guidance. Reg Anesth. 1993;18:63.

Waldman SD, Wilson WL, Kreps RD. Superior hypogastric plexus block using a single needle and computed tomography guidance: description of a modified technique. Reg Anesth. 1991;16:286-287.

Cariati M, De Martini G, Pretolesi F. CT-guided superior hypogastric plexus block. J Comput Assist Tomogr. 2002;26:428-431.

Chan WS, Peh WC, Ng KF. Computed tomography scan-guided neurolytic superior hypogastric block complicated by somatic nerve damage in a severely kyphoscoliotic patient. Anesthesiology. 1997;86:1429-1430.

Yeo SN, hong JL. A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix. Ann Acad Med Singapore. 2001;30:632-635.

Chaturvedi A, Dash HH. Sympathetic blockade for the relief of chronic pain. J Indian Med Assoc. 2001;99:698-703.

Orlandini G. Selection of patients undergoing neurolytic superior hypogastric plexus block. Pain. 1994;56:121-122.

De Leon-Casasola OA, Lema MJ. Selection of patients undergoing neurolytic superior hypogastric plexus block (Reply to Orlandini G). Pain. 1994;56:122.

Nezhat CH, Seidman DS, Nezhat FR. Long-term outcome of laparoscopic presacral neurectomy for the treatment of central pelvic pain attributed to endometriosis. Obstet Gynecol. 1997;90:974-977.

Stones RW, Mountfield J. Interventions for treating chronic pelvic pain in women. Cochrane Database Syst Rev. 2000;4.

Mercadante S. Opioid rotation for cancer pain: rational and clinical aspects. Cancer. 1999;86:1856-1866.

Zekry HA, Reddy SK. Opioid and nonopioid therapy in cancer pain: The traditional and the new. Curr Rev Pain. 1999;3:237-247.

A new approach to teaching the practice of medicine: Evidence-Based Medicine Working Group. Evidence-Based Medicine Working Group. JAMA. 1992;268:2420-2425.

Rosser WW. Application of evidence from randomized controlled trials to general practice. Lancet. 1999;353:661-664.

O Bloqueio do plexo hipogástrico superior é eficaz no tratamento de dor pélvica crônica?

Is superior hypogastric plexus block effective for treatment of chronic pelvic pain?

André P Schmidt; Sérgio R G Schmidt; Sady M Ribeiro

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Abstract

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