Fluroscopic Guided Splanchnic Plexus Neurolysis By Painex Pain academy скачать в хорошем качестве

Fluroscopic Guided Splanchnic Plexus Neurolysis By Painex Pain academy

Splanchnic Plexus Neurolysis: Overview #### Indications: Splanchnic plexus neurolysis is primarily indicated for patients experiencing severe chronic abdominal pain that is refractory (not responding) to conventional medical treatments. Common conditions where this procedure might be considered include: 1. **Pancreatic Cancer**: To alleviate pain associated with pancreatic cancer that has spread to nearby structures. 2. **Chronic Pancreatitis**: When pain management through medications or other interventions has been insufficient. 3. **Abdominal Visceral Pain Syndromes**: Such as pain from other abdominal cancers, chronic mesenteric ischemia, or visceral pain syndromes that do not respond to traditional therapies. #### Technique: The procedure typically involves the following steps: 1. **Patient Preparation**: The patient is positioned either prone or supine, depending on the approach chosen by the physician. 2. **Imaging Guidance**: Fluoroscopy (real-time X-ray) or CT scan guidance is often used to ensure accurate placement of the needles. 3. **Needle Placement**: A series of needles are inserted through the skin and advanced towards the splanchnic nerves under fluoroscopic or CT guidance. The exact nerves targeted depend on the specific pain pattern and underlying condition. 4. **Neurolytic Agent Injection**: Once the needles are in position near the splanchnic nerves, a neurolytic agent such as alcohol, phenol, or a local anesthetic mixed with a corticosteroid is injected. This agent disrupts the function of the nerves, thereby reducing pain signals transmitted to the brain. 5. **Post-procedure Care**: After the procedure, patients are monitored for a short period to manage any immediate discomfort and ensure there are no immediate complications. #### Contraindications: While splanchnic plexus neurolysis can be effective, it may not be suitable for all patients. Contraindications include: 1. **Infection at the Injection Site**: The procedure should be delayed until the infection resolves. 2. **Coagulopathy**: Patients with bleeding disorders or those on anticoagulant therapy may be at increased risk of bleeding complications. 3. **Allergy to Neurolytic Agents**: Some patients may have allergies or adverse reactions to the neurolytic agents used. 4. **Uncooperative Patient**: Patients who cannot cooperate during the procedure (e.g., due to mental status or inability to lie still) may not be suitable candidates. #### Complications: Like any medical procedure, splanchnic plexus neurolysis carries risks of complications, although they are generally uncommon. Potential complications include: 1. **Pneumothorax**: Especially with approaches that involve needle insertion near the diaphragm, there is a risk of puncturing the lung tissue. 2. **Bleeding**: Particularly in patients with underlying coagulopathies or vascular abnormalities. 3. **Nerve Injury**: There is a risk of unintentional damage to nearby nerves, which could result in sensory or motor deficits. 4. **Infection**: Although rare, any invasive procedure carries a risk of infection at the injection site. 5. **Pain Flare**: Some patients may experience a temporary exacerbation of pain before experiencing relief. 6. **Hypotension**: In rare cases, injection of neurolytic agents near sympathetic nerves can lead to a drop in blood pressure. Before undergoing splanchnic plexus neurolysis, patients should discuss the procedure thoroughly with their healthcare provider to understand the potential benefits, risks, and alternatives.