Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis

Sonal Goyal; Ajit Kumar; Divakar Goyal; Pradeep Attar; Baibhav Bhandari; Gaurav Purohit; Aditya Pal Mahiswar; Shiwam Gupta

doi:10.4103/ija.ija_439_23

Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis

Indian J Anaesth. 2023 Dec;67(12):1036-1050. doi: 10.4103/ija.ija_439_23. Epub 2023 Dec 13.

Authors

Sonal Goyal¹, Ajit Kumar², Divakar Goyal³, Pradeep Attar², Baibhav Bhandari², Gaurav Purohit⁴, Aditya Pal Mahiswar⁵, Shiwam Gupta²

Affiliations

¹ Department of Anaesthesiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
² Department of Anaesthesiology, AIIMS Rishikesh, Uttarakhand, India.
³ Department of Trauma Surgery, Adesh Medical College and Hospital, Near Ambala Cant, Haryana, India.
⁴ Department of Anaesthesiology, Army Hospital (R & R), New Delhi, India.
⁵ Department of Anaesthesiology, Fortis Memorial Research Institute, Gurugram, Haryana, India.

Abstract

Background and aims: Neurolytic splanchnic nerve block (NSNB) is practised in intractable abdominal pain secondary to intra-abdominal malignancies. This review evaluated the efficacy of NSNB.

Methods: PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2001 to October 2023. Two independent reviewers extracted the data from the included studies. The quality of randomised controlled trials (RCTs) was assessed using the revised Cochrane risk-of-bias tool (RoB 2), and the Newcastle-Ottawa scale was used for cohort studies.

Results: Fourteen articles (4 RCTs, 3 non-randomised prospective, and 7 retrospectives) were included. Ten articles were quantitatively assessed and demonstrated significant pain relief at 1 week (standardised mean difference (SMD): 3.46 [2.09, 4.83], P < 0.001, I² = 95%), 2 weeks (SMD: 4.45 [2.61, 6.29], P < 0.001, I² = 95%), 4 weeks (SMD: 3.35 [2.23, 4.47], P < 0.001, I² = 97%), 8 weeks (SMD: 3.7 [2.71, 4.7], P < 0.001, I² = 86%), 12 weeks (SMD: 4.01 [2.66, 5.36], P < 0.001, I² = 95%), and 24 weeks (SMD: 2.54 [1.71,3.37], P < 0.001, I² = 84%). Daily narcotic consumption and quality of life (QOL) significantly improved post neurolysis, but survival rates showed controversial results. Significant heterogeneity was reported, and sub-group analysis revealed a moderate level of variability [I² = 47.3%] pertaining to study design as a source of heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Pro GDT recommendation for the primary objective was 'high' for the analysis of RCTs and 'very low' evidence quality for observational studies. Only transient minor complications were reported.

Conclusion: NSNB appears to be an efficacious technique that provides substantial pain relief, reduces opioid consumption, and ameliorates QOL.

Keywords: Abdominal pain; chemical neurolysis; chronic pain; intractable pain; neoplasms; neurolysis; opioid; quality of life; splanchnic nerve block; sympathetic.