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Sympathetic blocks in cancer pain: coordinate based step-by-step fluoroscopic-guided transdiscal approach
  1. Victor M Silva-Ortiz1,2,
  2. Rodrigo Diez Tafur2,3,
  3. Ricardo Plancarte-Sanchez2,4,
  4. Christopher L Robinson5 and
  5. Alaa Abd-Elsayed6
  1. 1 Hospital Zambrano Hellion, San Pedro Garza Garcia, Mexico
  2. 2 Latin American Pain Society, New York, New York, USA
  3. 3 Pain Management, Lima Pain Institute, Lima, Peru
  4. 4 Pain Clinic, Mexico National Cancer Institute, Ciudad de Mexico, Mexico
  5. 5 Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School-Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  6. 6 Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
  1. Correspondence to Dr Victor M Silva-Ortiz; drvictorsilva{at}gmail.com

https://doi.org/10.1136/spcare-2024-004829

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    Introduction

    The transdiscal approach, as previously described, represents a significant advancement in interventional pain management.1 Our study introduces a novel coordinate system designed to enhance the safety and precision of sympathetic nerve blocks by using the transdiscal approach. By implementing this technique, our aim is to ensure patients receive optimal pain relief while mitigating the risk of inadvertent damage to surrounding tissues or organs.

    Our proposed methodology offers a versatile application for performing splanchnic nerve block (SNB), superior hypogastric plexus block (SHPB) and lumbar sympathetic block (LSB) via the transdiscal approach, discussed further below. Notably, our approach provides a comprehensive guide, complemented by illustrative images (figure 1), facilitating ease of adoption and proficiency. A key advantage lies in the utilisation of a single needle, strategically positioned to reach the target site with precision. Central to our technique is the imperative to maintain the needle tip at the centre and anterior aspect of the intervertebral disc, ensuring optimal efficacy and safety throughout the procedure.

    Figure 1

    (A) Axial image of the disc is divided into nine zones according to A, B, C in axial and 1, 2, 3 in the anteroposterior direction. (B) Lateral view of the disc is divided into 1 (posterior), 2 (medial) and 3 (anterior) zones. (C) Entry point (blue star). (D) Anteroposterior view with the needle tip in the 3B coordinate just before the loss of resistance technique. (E) Lateral view after the loss of resistance in the anterior part of 3B coordinate with contrast media injected. (F) Splanchnic nerve block. Green dot: needle entry point. Red dotted line: superior articular process. Purple dotted lines: rib. Blue lines: aligned endplates of the vertebral bodies. (G) Superior hypogastric block: green dot: Needle entry point. Red dotted line: S1 superior articular process. Purple dotted line: Iliac crest. Blue line: aligned inferior …

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    Footnotes

    • X @manejodeldolor

    • Contributors Study conception and design: VMS-O. Analysis and interpretation of results: VMS-O, RD-T, CLR, AA-E and RP-S. Draft manuscript preparation: VMS-O, RD-T, CLR, AA-E and RP-S. All authors reviewed the results and approved the final version of the manuscript. VMS-O is the guarantor.

    • Funding The author has any financial disclosures related to the content of this study. There was no external funding for this study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.