Anesthetic Bladder Hydrodistention Is Superior to Superior Hypogastric Plexus Neurolysis in Treatment of Interstitial Cystitis-bladder Pain Syndrome: A Prospective Randomized Trial.

OBJECTIVE: To evaluate efficacy and safety of superior hypogastric plexus neurolysis (SHN) for treatment of interstitial cystitis (IC)-bladder pain syndrome (BPS) in comparison with bladder hydrodistention (HD). MATERIALS AND METHODS: In a prospective study, 24 female patients were randomly allocated to receive either SHN or HD. Patients were evaluated by recording the O'Leary-Sant IC symptom indices, IC problem indices, pain visual analog scale (VAS), number of daytime frequency, and nocturia. Pressure flow study was conducted for all patients. Intraoperative and postoperative changes and adverse events were recorded. RESULTS: Basal IC symptom indices, IC problem indices, and VAS scores were comparable between both groups (P = .31, .63, and .94, respectively). There was no statistically significant difference between both groups with respect to urodynamic parameters. Only pain VAS at first week was improved in SHN in comparison with HD (P = .012). Thereafter, all parameters were significantly improved in favor of the HD group at 2- and 4-week visits. Adverse events in both groups were ranked as Grade 1 Clavien-Dindo classification including transient hematuria in the HD group and transient back ache in the SHN group. CONCLUSION: Despite effective pain control in cases with IC-BPS after SHN, it lacks durability. It seems that SHN in its current form is not to be a suitable line of treatment for IC-BPS. Multimodality treatment would be needed for proper control of patients' symptoms.

Single paravertebral injection for acute thoracic herpes zoster: a randomized controlled trial.

BACKGROUND: The aim of this study was to evaluate the efficacy of single thoracic paravertebral injection in acute thoracic herpes zoster (HZ) pain, eruptive duration, and the incidence of postherpetic neuralgia (PHN). METHODS: One hundred thirty-eight patients over 50 years of age with acute thoracic herpetic eruption were randomly assigned to receive a paravertebral block using either 10 mL saline (placebo group) or 25 mg bupivacaine, plus 8 mg dexamethasone in a total volume of 10 mL (active group). All the patients received pregabalin 150 mg twice daily. Acetaminophen was available as rescue analgesia. Pain severity was assessed using visual analog scale (VAS). Analgesics consumption was evaluated weekly. Time to pain resolution, healing of the skin eruption, and incidence of persistent postherpetic pain were reported. RESULTS: Significantly shorter duration of pain and herpetic eruption was noticed in the active group vs. placebo group (P = 0.013 and < 0.001, respectively). Active group showed significantly lower VAS at the third week. Significantly lower doses of pregabalin and acetaminophen were consumed in the active group. Incidence of PHN was comparable in both groups after 3 months (P = 0.094). A significantly lower incidence of PHN was noted in active treatment group at 6 months (P = 0.048). CONCLUSION: Early single paravertebral blockade in the course of acute thoracic HZ seems to be a safe and effective adjuvant treatment modality.

Neurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study.

CONTEXT: Sympathectomy is currently used as the fourth step of the modified World Health Organization (WHO) analgesic ladder. Sympathectomy can be performed early, before the second step on the ladder. OBJECTIVES: We hypothesized that early sympathectomy would reduce pain and opioid consumption and improve quality of life. METHODS: One hundred nine patients, with inoperable abdominal or pelvic cancer, reporting visceral pain of 40-70 on a visual analogue scale and taking nonopioid analgesics were allocated randomly into two groups: either blocks were performed before Step 2 of the WHO ladder, then analgesics were managed according to the ladder (Group I) or analgesics were given according to the WHO ladder, and blocks were performed as the fourth step after failure of strong opioids to control pain (Group II). Visual analogue scale scores, responder analysis, daily opioid consumption, related side effects, and quality of life were assessed. RESULTS: Responders were significantly higher in Group I (P < 0.0001), and partial responders and nonresponders significantly increased in Group II (P < 0.0001 and 0.006, respectively). Opioid consumption significantly decreased in Group I (P < 0.0001 during first 12 months and 0.007 at the last assessment time), with concomitant significant reduction in related side effects. The number of patients who had a good analgesic response on tramadol significantly increased in Group I during the first five months (P < 0.05). European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 global quality-of-life subscale scores revealed significant improvement until the fifth month in Group I (P < 0.05). CONCLUSION: Sympathectomy before Step 2 on the WHO analgesic ladder seems to lead to better pain control, less opioid consumption, and better quality of life in cancer patients.

Comparative study between 2 protocols for management of severe pain in patients with unresectable pancreatic cancer: one-year follow-up.

BACKGROUND: The efficacy of a celiac plexus block for the treatment of upper abdominal cancer-related pain has been documented. However, the effect of preprocedural pharmacological control of pain on its efficacy remains unknown. The researchers investigated the effect of first controlling severe pain with medications and then performing the celiac plexus block and compared the results with those obtained when the celiac block was performed first followed by pharmacotherapy for controlling severe pain; the impact on and duration of pain relief, effect on the quality of life, and analgesic requirements were analyzed. PATIENTS AND METHODS: Sixty patients with nonresectable pancreatic cancer reporting visual analog scale (VAS) ≥ 70 (visceral pain, continuous or intermittent) were randomized into 2 equal groups. Group I comprised patients in whom the celiac block was performed early after the first meeting and then analgesic requirements were managed according to the severity of pain and the World Health Organization analgesic ladder. Group II comprised patients in whom analgesics were first given to control pain and the celiac plexus block was performed only when the patients reported a VAS score < 40. VAS and total daily analgesic consumption were recorded before the block, followed by weekly for 1 month, monthly for 6 months, and finally in the 9th and 12th months. Patient satisfaction was assessed using a quality of life questionnaire (QLQ-C30). Patients were asked to report any side effects particularly related to the procedure and intake of opioids. RESULTS: Pain scores were comparable in both groups at initial assessment. However, in group II, VAS was reduced to 29.2 ± 4.48 in 8 ± 3 days through medical treatment before performing the block. At all time periods examined, pain scores were significantly lower in both groups compared with pretreatment scores (P < 0.0001). There was a significant decrease in VAS in group II when compared with group I at 2 months after the procedure and thereafter (P < 0.0001). Morphine sulfate consumption and frequency of opioid adverse effects were significantly lower in group II from the second month onward (P < 0.0001). The number of patients who showed good response to tramadol was significantly higher in group II in the second month until the 6th month (P < 0.05). QLQ-C30 was significantly lower in group II compared with group I from the 2nd month onward (P < 0.0001). CONCLUSIONS: Controlling severe pain with medication and then performing the celiac block seems to be more effective in controlling pain, reducing opioid consumption, and improving the quality of life of patients with pancreatic cancer compared with performing the celiac block at the beginning followed by pharmacotherapy for pain relief.