NEUROLYTIC SPLANCHNIC NERVE BLOCK WITH ALCOHOL FOR UPPER ABDOMINAL CANCER PATIENTS: A SYSTEMATIC REVIEW
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Keywords:
Neurolytic, Splanchnic, CancerAbstract
Pain is the most common symptom experienced by approximately 66% of patients with advanced, metastatic, or terminal cancer. Splanchnic nerve block with neurolytics can help reduce pain and is indicated for treating pain caused by malignant tumors in the retroperitoneum and upper abdomen. This systematic review used data from electronic databases (PubMed, ScienceDirect, ProQuest, and EPMC) to identify studies published in English between 2015 and 2025; five studies were included for review. Neurolytics with alcohol concentrations between 50% and 99.7% and injection volumes from 5 mL to >20 mL consistently provided significant pain reduction in patients with intra-abdominal pain due to cancer in the first three months. The potential for reducing opioid use and various techniques make splanchnic nerve neurolytics one of the therapeutic options in palliative pain management.
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References
1. World Health Organization. Who Guidelines for The Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva; 2018.
2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 71(3):209–49.
3. World Health Organization. Cancer. 2025.
4. Haroun R, Wood JN, Sikandar S. Mechanisms of cancer pain. Frontiers in pain research (Lausanne, Switzerland). 2022;3:1030899.
5. Bruce M. Vrooman, Kimberly M. Youngren. Chronic Pain Management. In: Butterworth JF, Mackey DC, Wasnick JD, editors. Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. New York : McGraw-Hill Education; 2022. p. 1127.
6. McCausland C, Carey FJ, Sajjad H. Anatomy, Back, Splanchnic Nerve. 2025.
7. Waldman SD, editor. Splanchnic Nerve Block: Single-Needle Technique. In: Atlas of Interventional Pain Management. 4th ed. Philadelphia: Elsevier; 2015. p. 367–80.
8. Gupta M, Abdallah R, Abd-Elsayed A, Chakravarthy K, Day M, Deer T, et al. A Review of Nonsurgical Neurolytic Procedures for Neuropathic Pain. J Pain Res. 2025 Feb;Volume 18:879–95.
9. Dong D, Zhao M, Zhang J, Huang M, Wang Y, Qi L, et al. Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial. Anesthesiology. 2021 Oct 9;135(4):686–98.
10. Koyyalagunta D, Engle MP, Yu J, Feng L, Novy DM. The Effectiveness of Alcohol Versus Phenol Based Splanchnic Nerve Neurolysis for the Treatment of Intra-Abdominal Cancer Pain. Pain Physician. 2016 May;19(4):281–92.
11. Koyyalagunta D, Mach S, Chung M. Comparison of Different Spinal Level Approaches in Splanchnic Sympathetic Neurolysis for Intractable Upper Abdominal Cancer Pain: A Retrospective Review. Pain Physician. 2025 Jul;28(4):E403–10.
12. Ahmed A, Arora D. Fluoroscopy-guided neurolytic splanchnic nerve block for intractable pain from upper abdominal malignancies in patients with distorted celiac axis anatomy: An effective alternative to celiac plexus neurolysis - A retrospective study. Indian J Palliat Care. 2017;23(3):274.
13. Cai Z, Zhou X, Wang M, Kang J, Zhang M, Zhou H. Splanchnic nerve neurolysis via the transdiscal approach under fluoroscopic guidance: a retrospective study. Korean J Pain. 2022 Apr 1;35(2):202–8.
14. Habib MH, Schlögl M, Raza S, Chwistek M, Gulati A. Interventional pain management in cancer patients—a scoping review. Ann Palliat Med. 2023 Nov;12(6):1198–214.
15. Mestdagh F, Steyaert A, Lavand’homme P. Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques. Current Oncology. 2023 Jul 18;30(7):6838–58.
16. Kim SY, Oh HK, Yoon DM, Shin YS, Lee YW, Kim JR. A Clinical Evaluation of Splanchnic Nerve Block. Korean J Anesthesiol. 1986;19(6):550.
17. Ma L, Wang R, Li L. Efficacy and Safety of Splanchnic Nerve Neurolysis via the Transdiscal Approach Using CT/Ultrasound Dual-Guided Posterior Approach in the Management of Upper Abdominal Cancer Pain: A Retrospective Analysis. J Pain Res. 2025 Nov;Volume 18:5881–90.
18. Paul A, Borkar A. Fluoroscopy-Guided Splanchnic Nerve Block for Cancer-Associated Pain. Cureus. 2022 Oct;14(10):e30944.
19. Ardon AE, Lee J, Franco CD, Riutort KT, Greengrass RA. Paravertebral block: anatomy and relevant safety issues. Korean J Anesthesiol. 2020 Oct 1;73(5):394–400.
20. Silva V, López AG, Martínez L. Splanchnic Nerve Neurolysis: Double Access for Abdominal Cancer Pain. BMJ Support Palliat Care. 2023 Nov;13(e2):e260–1.
21. Herrero Trujillano M, Mendiola De La Osa A, Insausti Valdivia J, Pérez Cajaraville J. Neurolytic procedures for pancreatic cancer pain. Revista de la Sociedad Española del Dolor. 2019;
22. Silva-Ortiz VM, Plancarte-Sanchez R, Hernández-Porras BC. Comments on splanchnic nerve neurolysis via the transdiscal approach under fluoroscopic guidance: a retrospective study. Korean J Pain. 2022 Jul 1;35(3):356–7.
23. Abdel Shaheed C, Hayes C, Maher CG, Ballantyne JC, Underwood M, McLachlan AJ, et al. Opioid analgesics for nociceptive cancer pain: A comprehensive review. CA Cancer J Clin. 2024 May 18;74(3):286–313.
24. Al-Kutoubi A. How I Do It: Celiac and Splanchnic Plexus Neurolysis. The Arab Journal of Interventional Radiology. 2018 Jan 26;2(01):04–7.
25. Comlek S. Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis. J Pain Res. 2020 Aug;Volume 13:2023–31.
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