Dexmedetomidine in Splanchnic Nerve Neurolysis
Condition: Dexmedetomidine
MeSH terms: Cancer Pain
Study type: Interventional

Summary: 
      Malignancy related abdominal and pelvic pain can be debilitating and affects survival as well
      as quality of life. Pain from cancer and its treatments can result in anxiety, depression,
      fear, anger, helplessness, and hopelessness, and those with both pain and depression have an
      amplification of disability and poor quality of life Pancreatic and other upper abdominal
      organ malignancies can produce intense visceral pain syndromes that are frequently treated
      with splanchnic nerve neurolysis (SNN) or celiac plexus neurolysis (CPN). Dexmedetomidine is
      a selective alpha two adreno-receptor agonist. It provides dose-dependent sedation,
      analgesia, sympatholysis, and anxiolysis without relevant respiratory depression.
      Dexmedetomidine is used as adjuvant to LA drugs in peripheral nerve block, brachial plexus
      block and intrathecal anesthesia with satisfactory results. The aim of this study is to
      evaluate effect of addition of dexmedetomidine as an adjuvant to alcohol and local
      anesthetics for chemical neurolysis to control pain in patients with intra-abdominal
      malignancy.
    

Detailed description: 
      Patients fasted for 6 hours prior to the procedure, and a 20 G intravenous cannula was
      placed. Before the procedure, 500 mL of physiological saline was administered intravenously.
      The patient was positioned in the prone position on the surgical table with the chest
      supported using a pillow, to reverse the thoracolumbar lordosis and to increase the distance
      between the superior iliac spine and the chest cage. The patient was monitored using
      electrocardiography, non-invasive blood pressure measurements, and pulse oximetry in
      accordance with the standards proposed by the American Association of Anesthesiologists. On
      arrival at the operating room, electrocardiogram, pulse oximetry, and non-invasive arterial
      blood pressure were applied and vital signs were obtained.

      Twenty-two Gauge spinal needle introduced at 11th intercostal space 6 cm from midline and
      advanced to touch the anterolateral aspect of T11. Again, with AP and lateral views the
      placement of the needles was confirmed using contrast dye under fluoroscopy.

      Splanchnic nerve blockade will be performed by using (4.5 ml ethanol 96% + 1.5 ml of
      lidocaine 10 mg/ml) administered bilaterally (a total volume of 12 ml) with addition of 2
      μg/kg dexmedetomidine patients in group (1).

      The procedure lasted 30 minutes, and the recovery period lasted 10 minutes since conscious
      sedation was used. After the procedure, patients were kept under medical observation for 4 to
      6 hours to monitor possible hemodynamic complications.

      Parameters assessed:

        1. Hemodynamic parameters: Heart rate, respiratory rate and oxygen saturation were recorded
           before and immediately after the blockade and follow up on time intervals over 2 weeks
           after the blockade.

        2. Analgesic requirements: First time to require additional analgesics

        3. Visual Analogue Scale: The Visual Analogue Scale score (VAS) consists of a straight line
           with the endpoints defining extreme limits such as 'no pain at all' and 'pain as bad as
           it could be'.The score of pain intensity was determined by patients providing a mark
           between 0-10 cm with score from 0-4 cm mild pain. 5- 7 cm moderated and 8-10 severe pain

        4. Incidence of complications: In the form of hemodynamic instability, constitutional
           symptoms as (nausea, vomiting and diarrhea)
    

Intervention name(s): Group 1; Group 2
Intervention type(s): Drug; Drug
Intervention description(s): Is formed of 20 patients had splanchnic plexus block with 4.5 ml ethanol 96% + 1.5 ml of lidocaine 10 mg/ml + 2 μg/kg dexmedetomidine diluted in 0.9% sterile saline (total volume 12 ml) on each side; Is formed of 20 patients had splanchnic plexus block with 4.5 ml ethanol 96% + 1.5 ml of lidocaine 10 mg/ml diluted in 0.9% sterile saline (total volume 12 ml) on each side.
Other intervention name(s): dexmedetomidine; ethanol
Intervention MeSH terms: Ethanol; Dexmedetomidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Splanchnic Nerve Neurolysis; Chronic cancer Pain