Current Pain and Headache Reports ( IF 3.7 ) Pub Date : 2021-02-25 , DOI: 10.1007/s11916-020-00933-0 Ivan Urits 1, 2 , Ruben Schwartz 3 , Jared Herman 3 , Amnon A Berger 1 , David Lee 4 , Christopher Lee 5 , Alec M Zamarripa 4 , Annabel Slovek 6 , Kelly Habib 4 , Laxmaiah Manchikanti 7 , Alan D Kaye 2 , Omar Viswanath 2, 4, 6, 8
Purpose of Review
This is a comprehensive review of the superior hypogastric block for the management of chronic pelvic pain. It reviews the background, including etiology, epidemiology, and current treatment available for chronic pelvic pain. It then presents the superior hypogastric block and reviews the seminal and most recent evidence about its use in chronic pelvic pain.
Recent Findings
Several definitions exist for chronic pelvic pain (CPP), making the diagnosis more challenging for the clinician; however, they commonly describe continuous pain lasting 6 months in the pelvis, with an overwhelming majority of patients being reproductive-aged women. This pain is often one of mechanical, inflammatory, or neuropathic. It is generally underdiagnosed and affects anywhere between 5 and 26% of women. The diagnosis of chronic pelvic pain is clinical, consisting of mainly of a thorough history and physical and ruling out other causes. The pathophysiology is often endometriosis (70%) and also includes PID, adhesions, adenomyosis, uterine fibroids, chronic processes of the GI and urinary tracts, as well as pelvic-intrinsic musculoskeletal causes. Treatment includes physical therapy, cognitive behavioral therapy, and oral and parenteral opioids. Interventional techniques provide an added tier of treatment and may help to reduce the requirement for chronic opioid use. Superior hypogastric plexus block is one of the available interventional techniques; first described in 1990, it has been shown to provide long-lasting relief in 50–70% of patients who underwent the procedure. Two approaches described so far, both under fluoroscopy, have seen similar results. More recently, ultrasound and CT-guided procedures have also been described with similar success. The injectate includes local anesthetic, steroids, and neurolytic agents such as phenol or ethanol.
Summary
CPP is a common debilitating condition. It is diagnosed clinically and is underdiagnosed globally. Current treatments can be helpful at times but may fall short of satisfactory pain relief. Interventional techniques provide an added layer of treatment as well as reduce the requirement for opioids. Superior hypogastric plexus block provides long-lasting relief in many patients, regardless of approach. Evidence level is limited, and further RCTs could help provide better tools for evaluation and patient selection.
中文翻译:
用于治疗慢性盆腔痛的上腹部下阻滞的全面更新
审查目的
这是对用于治疗慢性盆腔疼痛的上腹下腹阻滞的综合评价。它回顾了背景,包括病因、流行病学和当前可用于慢性盆腔疼痛的治疗方法。然后介绍上腹下神经阻滞并回顾有关其在慢性盆腔痛中使用的开创性和最新证据。
最近的发现
慢性盆腔痛 (CPP) 存在多种定义,这使得临床医生的诊断更具挑战性;然而,他们通常描述骨盆持续疼痛持续 6 个月,绝大多数患者是育龄妇女。这种疼痛通常是机械性、炎症性或神经性疼痛之一。它通常未得到充分诊断,影响了 5% 至 26% 的女性。慢性盆腔疼痛的诊断是临床的,主要包括完整的病史和身体状况以及排除其他原因。病理生理学通常是子宫内膜异位症 (70%),还包括 PID、粘连、子宫腺肌症、子宫肌瘤、胃肠道和泌尿道的慢性过程,以及盆腔内在的肌肉骨骼原因。治疗包括物理治疗、认知行为治疗、以及口服和肠胃外阿片类药物。介入技术提供了额外的治疗层次,可能有助于减少长期使用阿片类药物的需求。上腹下神经丛阻滞是可用的介入技术之一;1990 年首次描述,它已被证明可以为接受该手术的 50-70% 的患者提供持久的缓解。迄今为止描述的两种方法都在透视下看到了相似的结果。最近,超声和 CT 引导程序也取得了类似的成功。注射液包括局部麻醉剂、类固醇和神经溶解剂,如苯酚或乙醇。上腹下神经丛阻滞是可用的介入技术之一;1990 年首次描述,它已被证明可以为接受该手术的 50-70% 的患者提供持久的缓解。迄今为止描述的两种方法都在透视下看到了相似的结果。最近,超声和 CT 引导程序也取得了类似的成功。注射液包括局部麻醉剂、类固醇和神经溶解剂,如苯酚或乙醇。上腹下神经丛阻滞是可用的介入技术之一;1990 年首次描述,它已被证明可以为接受该手术的 50-70% 的患者提供持久的缓解。迄今为止描述的两种方法都在透视下看到了相似的结果。最近,超声和 CT 引导程序也取得了类似的成功。注射液包括局部麻醉剂、类固醇和神经溶解剂,如苯酚或乙醇。
概括
CPP 是一种常见的使人衰弱的疾病。它在临床上被诊断出来,但在全球范围内诊断不足。目前的治疗有时会有所帮助,但可能无法令人满意地缓解疼痛。介入技术提供了额外的治疗层,并减少了对阿片类药物的需求。无论采用何种方法,优越的腹下神经丛阻滞可为许多患者提供持久的缓解。证据水平有限,进一步的 RCT 可以帮助为评估和患者选择提供更好的工具。