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Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e3182869d68
Original Articles

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*,§

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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.

Copyright © 2013 by Lippincott Williams & Wilkins

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