Neurolytic Visceral Sympathetic Blocks

Neurolytic sympathetic blocks can be very helpful in controlling pain that is visceral in origin. Visceral pain can occur when visceral structures are involved with cancer due to pressure, invasion, or stretching. Visceral pain can be dull, squeezing, and poorly localized. Referred pain can occur due to visceral pain. For example, patient can experience pain in the shoulder when the diaphragm is involved in the tumor. Sympathetic block can help visceral pain only. This means that other forms of pain that may be associated with the tumor cannot be affected and does not mean that the block is not successful. Visceral pain is transmitted along the

Cervicothoracic ganglia

Brain, meninges, eyes, ears, tongue, pharynx, larynx, glands and skin of head, neck and upper extremities

Thoracic ganglia Mediastinal contents, esophagus, trachea, bronchi, pericardium, heart, thoracic aorta, pleura, lungs Celiac plexus

Gastrointestinal tract (distal esophagus to mid-transverse colon), liver, adrenals, ureters, abdominal vessels Lumbar ganglia

Skin and vessels of lower extremities, kidneys, ureters, transverse colon, testes Hypogastric plexus

Descending sigmoid colon, rectum, vaginal fundus, bladder, prostate, prostatic urethra, testes, seminal vesicles, uterus and ovaries

Ganglion impar

Perineum, distal rectum and anus, distal urethra, vulva, and distal third of vagina

Figure 28.4 Schematic outline of the sympathetic nervous system with ganglia amenable to blockade highlighted.

sympathetic nervous system from the involved organ, relaying in para-vertebral ganglia that lie along the anterolateral portion of the vertebral column (Fig. 28.4). These ganglia are in perfect location for neurolytic destruction in case of cancer pain

Before performing any neurolytic block the physician should obtain pain history, and physical examination with identification of cancer as the main reason of pain. Neurological examination is mandatory before performing neurolytic blocks in order to identify any preexisting neurological deficit. The physician should perform examination of the site of the block to identify the presence of any infection and obtain coagulation profile including PT, INR, PTT, and platelet count because some of the cancer medications can affect platelets function and coagulation factors. The patient should have received appropriate trials of opioid and there should be a documentation of intolerance to opioids or ineffectiveness of opioids in relieving pain, despite increasing the dose. The physician should also obtain informed consent, explain in detail the procedure to the patient and also to the family if required, explain in detail and document all the risks and benefits of the blocks including the alternatives, the projected analgesic response, and the expected goals of therapy. Performance of local anesthetic block prior to neurolytic block is essential. This will enable the patient to be aware of the effect and possible side effects of the block, and also it will the patient and the healthcare providers to identify any neurologic deficits that may be intolerable to the patient. The most common neurolytic agents are alcohol or phenol. They both have equal effects. Table 28.6 shows the differences between alcohol and phenol as neurolytic agents.

Figure 28.4 Schematic outline of the sympathetic nervous system with ganglia amenable to blockade highlighted.

Table 28.6 Differences between alcohol and phenol as neurolytic agents.






Additives usually used

Local anesthetics (to relieve pain on injection)



Visceral ganglion neurolysis, subarachnoid injection, or peripheral


nerve injection

Patient response on injection

Pain (added local A. is helpful while keeping the concentration of

Warm sensation. Usually no

alcohol above 50%)

pain. It has local anesthesia.


Physical characters

Unstable at room temperature. Vials should open just priorto




Hypobaric (i.e., will raise up in CSF)

Hyperbaric (i.e., will sink in



2-4 days

1-2 days

Duration of block



Neuronal generation



CSF=cerebrospinal fluid.

CSF=cerebrospinal fluid.

Was this article helpful?

0 0
10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook

Post a comment