Comparison between radiofrequency ablation and chemical neurolysis of thoracic splanchnic nerves for the management of abdominal cancer pain, randomized trial

Abstract

BACKGROUND: Radiofrequency ablation (RFA) of the splanchnic nerves has been reported as a predictable and safe technique for abdominal pain management. We compare between RFA and chemical neurolysis of bilateral thoracic splanchnic nerves in the management of refractory cancer pain. METHODS: The study was conducted on 60 patients aged ≥18 years who suffered from abdominal pain (visceral pain, VAS ≥4) due to upper abdominal cancers. Participants were randomized into two groups. Group I (RF): 30 participants received a bilateral splanchnic nerve block at T10 and T11 levels using RFA. Group II (alcohol): 30 participants received a bilateral splanchnic nerve block at T11 using alcohol. Pain relief was assessed using VAS (0-10) and total daily oral opioid consumption (primary outcome). RESULTS: Significant reductions of VAS and global perceived effect satisfaction scores (GPES) were observed in both groups compared to baseline levels (p < 0.001); Group I had the largest reduction. MST consumption and QOL scores improved significantly in both groups (p < 0.001). Oral opioid consumption started to reduce at the end of the first post-interventional week for Group I, 0.00 (0-45 mg), and at the end of the second post-interventional week for Group II, 20.00 (0-135 mg). No major complications were recorded in either group. CONCLUSION: Simultaneous bilateral pain block of splanchnic nerves at the levels of T10 and T11 using RFA is more effective than using alcohol at a single level of T11 in cancer patients presenting with upper abdominal pain. The RFA intervention acted faster, provided longer duration analgesia, worked in a higher proportion of patients and had a better safety profile than the alcohol intervention. SIGNIFICANCE: Radiofrequency ablation of the splanchnic nerves is safe and effective for relieving upper abdominal cancer pain.