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

Kroll, Caleb E. MD*; Schartz, Brandon MD*; Gonzalez-Fernandez, Marlis MD, PhD; Gordon, Andrew H. MD, PhD; Babade, Mosunmola MD; Erdek, Michael A. MD*; Mekhail, Nagy MD, PhD; Cohen, Steven P. MD*,§

doi: 10.1097/AJP.0b013e3182869d68
Original Articles

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.

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

Selected as one of top 3 resident papers at the 2012 American Society of Regional Anesthesia & Pain Medicine Annual Fall Meeting for presentation, Miami, FL, November 2012.

The authors declare no conflict of interest. S.P.C. is funded by the Centers for Rehabilitation Sciences Research, Washington, DC, and the Defense and Veterans Center for Integrative Pain Management, Rockville, MD.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Reprints: Steven P. Cohen, MD, 550 North Broadway, Suite 301, Baltimore, MD 21029 (e-mail: scohen40@jhmi.edu).

Received October 1, 2012

Accepted January 7, 2013

© 2014 by Lippincott Williams & Wilkins