[Splanchnic nerve blocks by alcoholisation in pancreatico-solar hyperalgia of tumoral origin (author's transl)].

Abstract

Fifty-eight coelio-splanchnic nerve blocks by alcoholisation were done for thirty-two patients at the regional Center of the Fight against Cancer at Montpellier for persistent neoplastic pain of the pancreatico-solar type. In 15 cases (46,6 p. cent), the pancreatico-solar syndrome is the initial sign of a primitive or secondary supra-mesocolic cancer. In 12 cases, the hyperalgic syndrome discloses the extension or recidive of the tumor. According to etiologies, the illnesses were as follows: --pancreatic neoplasias I or II: 13 cases, --hepato-biliary lesions I or II: 11 cases, --peritoneal carcinosis: 4 cases, --invasion of retro-peritoneal nodes: 4 cases. Epigastric pain irradiating to the left para-vertebral area are resistant to analgesias; 95 p. cent of these patients received morphinic drugs for several days, if not weeks. The splanchnic nerves were reached by a posterior high lumbar injection according to the Kappis and Labat technic. A block with 2 p. cent lidocaine is immediately followed by alcoholisation by 99,8 p. cent ethanol. According to patient status, the blocks to the left and right were done at once or at several visits. The block by lidocaine gives immediate analgesia thereby indicating the proper placement of the injection. The coeliac alcoholisation assures the neurolysis of the splanchnic nerves. The antalgic effect lasts a variable time, averaging 42 days (varying from 2 to 240 days). The antalgic action always allows the discontinuation of morphinic drugs and increases the efficacy of minor analgesics, if necessary. All the same, 18/25 received morphine during their last few days before death.