Sphlanchic nerve radiofrequency ablation for chronic pancreatitis

Authors

  • Chandra Shekhar Karmakar Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
  • Rajat Shuvra Das Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
  • Saiful Mahmud Tusher Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
  • Ayesha Sultana Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
  • Kazi Mahzabin Arin Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
  • A. K. M. Habibullah Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh
  • Atidh Muhammad Molla Department of Anaesthesia and pain medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20242588

Keywords:

Chronic pancreatitis, Pain management, Sphlanchic nerve, Radiofrequency ablation

Abstract

Background: Chronic pancreatitis (CP) is defined as a progressive inflammatory response of the pancreas leading to irreversible changes in the parenchyma (fibrosis, loss of acini and islets of langerhans, and pancreatic stone formation) and pancreatic duct (stenosis and pancreatic stones).

Methods: This was a retrospective observational study and was conducted in Rushmono pain clinic at Rushmono Specialized Hospital, Dhaka, Bangladesh during the period from January 2018 to January 2024. In our study, we included 50 hospitalized patients who had undergone splanchnic nerve RFA ablation for pain of chronic pancreatitis.

Result: We found the mean age was 32.8±9.3 years. Most of our patients were male (78%) compared to female (22%). Among our patients, 78% were smokers, 62% of patients consumed alcohol and 42% had a history of hypertension. All of our patients (100%) had bilateral RFSN.  At baseline, the mean VAS score was 9.84±1.02 and in 1st postoperative day, the mean VAS score was 4.14±1.03 with a significant p value (0.021). At the 12th month of follow-up, the mean VAS score slightly increased to the last follow-up and the difference was not significant. The majority (84%) of our patients had no complications.

Conclusion: Our findings suggest that RFSN is likely a safe, minimally invasive way to manage pain in people with chronic pancreatitis. In the current study, our patients' mean VAS scores of pain levels significantly dropped after RFSN procedures.

References

Puylaert M, Kapural L, Van Zundert J, Peek D, Lataster A, Mekhail N, et al. Pain in chronic pancreatitis. Evidence‐based interventional pain medicine: According to Clinical Diagnoses. 2011;11:492-505.

Hayakawa T, Kondo T, Shibata T, Sugimoto Y, Kitagawa M. Chronic alcoholism and evolution of pain and prognosis in chronic pancreatitis. Dig Dis Sci. 1989;34:33-8.

Ammann RW, Heitz PU, Kloppel G. Course of alcoholic chronic pancreatitis: a prospective clinic morphological long-term study. Gastroenterology. 1996;111:224-31.

Behrman SW, Fowler ES. Pathophysiology of chronic pancreatitis. Surg Clin North Am. 2007;87:1309-24.

Apte MV, Pirola RC, Wilson JS. Molecular mechanisms of alcoholic pancreatitis. Dig Dis. 2005;23:232-40.

Levy P, Lesur G, Belghiti J, Fekete F, Bernades P. Symptomatic duodenal stenosis in chronic pancreatitis: a study of 17 cases in a medical-surgical series of 306 patients. Pancreas. 1993;8:563-7.

Steer ML, Waxman I, Freedman S. Chronic pancreatitis. N Engl J Med. 1995;332:1482-90.

Xu GY, Winston JH, Shenoy M, Yin H, Pasricha PJ. Enhanced excitability and suppression of A-type K+ current of pancreas-specific afferent neurons in a rat model of chronic pancreatitis. Am J Physiol Gastrointest Liver Physiol. 2006;291:424-31.

Vera-Portocarrero L, Westlund KN. Role of neurogenic inflammation in pancreatitis and pancreatic pain. Neurosignals. 2005;14:158-65.

Pezzilli R, Morselli Labate AM, Ceciliato R. Quality of life in patients with chronic pancreatitis. Dig Liver Dis. 2005;37:181-9.

Wehler M, Nichterlein R, Fischer B. Factors associated with health-related quality of life in chronic pancreatitis. Am J Gastroenterol. 2004;99:138-46.

Warshaw AL, Banks PA, Fernandez-Del Castillo C. AGA technical review: treatment of pain in chronic pancreatitis. Gastroenterology. 1998;115:765-76.

Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat 2010;23:512-22.

Verhaegh BP, van Kleef M, Geurts JW, Puylaert M. Percutaneous radiofrequency ablation of the splanchnic nerves in patients with chronic pancreatitis: results of single and repeated procedures in 11 patients. Pain Practice. 2013;13(8):621-6.

Lounsberry WG, Linke C. The early histological changes following electrocoagulaton. Gastrointest. Endosc. 1995;41:60-8.

Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg. 2005;75(8):640-4.

Ammann RW, Akovbiantz A, Largiader F, Schueler G. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology. 1984;86:820-8.

Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993;54:148-55.

Lowenfels AB, Maisonneuve P, Cavallini G. Pancreatitis and the risk of pancreatic cancer. N Engl J Med. 1993;328:1433-7.

Bornman PC, Marks IN, Girdwood AW, Berberat PO, Gulbinas A, Buchler MW. Pathogenesis of pain in chronic pancreatitis: ongoing enigma. World J Surg. 2003;27:1175-82.

Walega D, Roussis C. Third-Degree burn from cooled radiofrequency ablation of medial branch nerves for treatment of thoracic facet syndrome. Pain Pract Off J World Inst Pain. 2014;14:154-8.

Muhlner SB. Review article: Radiofrequency neurotomy for the treatment of sacroiliac joint syndrome. Curr Rev Musculoskelet Med 2009; 2:10-14.

Abbott Z, Smuck M, Haig A, Sagher O. Irreversible spinal nerve injury from dorsal ramus radiofrequency neurotomy: A case report. Arch Phys Med Rehabil. 2007;88:1350-2.

Kappis M. Erfahrungen mit lokalanasthesie bei bauchoperationen. Verhandl Deutch Gesellsch F Cir. 1914;43:87.

Mallet-Guy P. La splanchnicectomie guache dans le traitement des pancreatitis chroniques. Presse Med. 1943;51:234-48.

Mallet-Guy P. Later and very late results of resections of the nervous system in the treatment of chronic relapsing pancreatitis. Am J Surg. 1983;145:234-8.

Evrard S. Surgical lesioning of splanchnic nerves using wet needle radiofrequency thermoblation. J. Surg. Oncol. 2002;80:171-2.

Charlton JE. Relief of the pain of unresectable carcinoma of pancreas by chemical splanchnicectomy during laparotomy. Ann R Coll. Surg. Engl. 1985;67:136-7.

Strickland T, Ditta TL, Ripelle JM. Performance of local anaesthetic and placebo splanchnic blocks via indwelling catheters to predict benefit from thorascopic splanchnicectomy in a patient with intractable pancreatic pain. Anaesthesiology. 1996; 84:980-3.

Lin CC, Mo LR, Lin YW, Yau MP. Bilateral thorascopic lower sympathetic-splanchnicectomy for upper abdominal cancer pain. Eur J Surg Suppl. 1994;572:59-62.

Inderbitzin D, Schmid RA, Schob O, Weder W. Surgical pain therapy in inoperable metastatic epigastric tumours by bilateral thorascopic splanchnicectomy. Schweiz. Med. Wochenscr. 1998;128:1408-13.

Levy BA. Diagnostic, prognostic and therapeutic nerve blocks. Arch. Surg. 1977; 112: 870–9.

Raj PP, Sahinler B, Lowe M. Radiofrequency lesioning of splanchnic nerves. Pain Pract. 2002;2:241-7.

Raj PJ, Lou L, Erdine S, Staats PS, Waldman SD. Radiographic imaging for regional anaesthesia and pain management. London. Churchill Livingstone. 2003.

Marra V, Debernardi F, Frigerio A, Menna S, Musso L, Di Virgilio M. Neurolytic block of the celiac plexus and splanchnic nerves with computed tomography. The experience in 150 cases and optimisation of the technique. Radiol. Med. 1999;98:183-8.

Fujita Y. CT-guided neurolytic splanchnic nerve block with alcohol. Pain. 1994;57:255-6.

Prithvi Raj P, Sahinler B, Lowe M. Radiofrequency lesioning of splanchnic nerves. Pain Prac. 2002;:241-7.

Papadopoulos D, Kostopanagiotou G, Batistaki C. Bilateral thoracic splanchnic nerve radiofrequency thermocoagulation for the management of end-Stage pancreatic abdominal cancer pain. Pain Physician 2013;16:125-33.

Gaudy JH, Trico C, Sezeur A. Serious heart disorders following perioperative splanchnic nerve phenol nerve block. Can J.= Anaesth. 1993;40:357-9.

Rosenthal JA. Diaphragmatic paralysis complicating alcohol splanchnic nerve block. Anesth Analg. 1998;86:846.

Raj PP, Lou L, Erdine S, Staats PS, Waldman SD, Racz G, et al. Interventional pain management: image-guided procedures. Churchill Livingstone Philadelphia. 2007:263-4.

Downloads

Published

2024-08-31

How to Cite

Karmakar, C. S., Das, R. S., Tusher, S. M., Sultana, A., Arin, K. M., Habibullah, A. K. M., & Molla, A. M. (2024). Sphlanchic nerve radiofrequency ablation for chronic pancreatitis. International Journal of Research in Medical Sciences, 12(9), 3149–3154. https://doi.org/10.18203/2320-6012.ijrms20242588

Issue

Section

Original Research Articles