Mercadante, S., Klepstad, P., Kurita, G.P., Sjogren, P., Giarratano, A., & European Palliative Care Research Collaborative (EPCRC). (2015). Sympathetic blocks for visceral cancer pain management: A systematic review and EAPC recommendations. Critical Reviews in Oncology/Hematology, 96, 577–583.

STUDY PURPOSE: To review in literature the effectiveness of sympathetic blocks in clinical trials. Both, neurolytic blocks of sympathetic as celiac plexus block (CPB) and superior hypogastric plexus block (SHPB), used for visceral abdominal pain in patients with pancreatic and gynaecologic cancer

TYPE OF STUDY: Systematic review

DATABASES USED: MedLine, Embase, and Cochrane Central Register of Controlled Trials

YEARS INCLUDED: Through February 2014

INCLUSION CRITERIA: Trials, both; neurolytic blocks of sympathetic as celiac plexus block (CPB) and superior hypogastric plexus block (SHPB), compared to analgesia or placebo, adult cancer patients and English language

EXCLUSION CRITERIA: Double publications, other clinical indications related, if only complications from sympathetic blocks reported

TOTAL REFERENCES RETRIEVED: 121

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Eligible trials were analyzed using the GRADE system

FINAL NUMBER STUDIES INCLUDED: 27 clinical trials 

TOTAL PATIENTS INCLUDED IN REVIEW: Not specified

SAMPLE RANGE ACROSS STUDIES: Sample range from 20 to 137

KEY SAMPLE CHARACTERISTICS: Pancreatic cancer for the CPB and pelvic pain related to gynecologic cancer for SHPB all of them requiring analgesia for their pain

PHASE OF CARE: Not specified or not applicable     
APPLICATIONS: Palliative care

CPB versus analgesia significantly decreased pain intensity, use of opioids, and reported less side-effect and better quality of life. SHPB versus morphine was more effective in only one RCT with 50 patients with gynecologic cancer that resulted in decrease in pain and less morphine.

Both, neurolytic blocks techniques, are sure and with few complications. Both are effective to reduce pain and to decrease use of opioids, less data is available from SPHB. Individual complete assessment in each patient is needed before deciding the technique to be done.

• Mostly low quality/high risk of bias studies
• High heterogeneity
• Low sample sizes
• No intention to treat analysis

No evidence can indicate the use of one or the other of the neurolytic blocks. Although celiac plexus block (CPB) seems recommended for pancreatic cancer pain, best timing for the technique is still uncertain. For superior hypogastric plexus block (SHPB) only after personalized evaluation in each case.