The thoracic splanchnic nerve block has been used in managing abdominal pain, especially for pains arising from abdominal cancers. A 27-year-old male patient who had a constant abdominal pain was referred to our clinic for pain management but had no organic disease. The numeric rating scale (NRS) for pain scored 7/10. We applied a diagnostic thoracic splanchnic nerve block under the diagnosis of functional abdominal pain syndrome. Since the block reduced the pain, we applied a radiofrequency thermocoagulation at the T11 and T12 vertebral level. Thereafter, his symptoms improved markedly with pain decreasing to an NRS score of 2-3/10. Hereby, we report a successful management of functional abdominal pain via radiofrequency thermocoagulation of the thoracic splanchnic nerves.
Abdominal Pain ; Adult ; Electrocoagulation ; Humans ; Male ; Pain Management ; Splanchnic Nerves

Celiac plexus neurolysis is performed to relieve intractable upper abdominal pain. Since Kappis had performed splanchnic nerve block in 1919, many methods and its modifications of celiac plexus block have been introduced. In 1983, Ischia and in 1990, Lieberman has introduced the transaortic technique of celiac plexus block. We employed a transaortic approach with some modification of the original method in 12 patients, in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit the drug directly onto the celiac plexus. After needle has punctured anterior wall of aorta, 50% alcohol 20ml was injected and after retracting the needle to the posterior wall of aorta, also 50% alcohol 20ml was injected. 11 patients experienced marked pain relief and no major complication was encountered. The authors think that our method has some theoretical benefits in effectiveness than the original transaortic method.
Abdominal Pain ; Aorta ; Celiac Plexus* ; Humans ; Needles* ; Splanchnic Nerves

The splanchnic nerve block can be an alternative method for the pain control in the upper abdomen, when the celiac plexus block does not work. And the radiofrequency thermocoagulation has benefits over alcohol or phenol block because its effect is more localized and predictable. This report describe two patients with metastatic cancer pain in the abdominal cavity who successfully treated with the splanchnic nerve block by using radiofrequency thermocoagulation.
Abdomen ; Abdominal Cavity ; Abdominal Pain* ; Celiac Plexus ; Electrocoagulation* ; Humans ; Nerve Block ; Phenol ; Splanchnic Nerves*

PURPOSE: Pain is the most distressing feature of cancer patients. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain. We wish to introduce a method of splanchnicectomy. METHODS: Five patients underwent a splanchnicectomy for intractable cancer pain, over a period of 11 months. We evaluated the type of splanchnicectomy performed and the results. The procedure was done using a double lumen catheter to deflate the lung at the operation side under general anesthesia with the patient in the lateral decubitus position. A small opening was made with scissors in the pleura of the 5th intercostal space to expose the terminal branch of the greater splanchnic nerve. Six-Seven branches of splanchnic nerve were cut downward until the splanchnic nerve trunk and then cut. A left thoracoscopic splanchnicectomy was done in one case, and a bilateral thoracoscopic splanchnicectomy in four cases. RESULTS: The splanchicectomy appears to result in significant reduction of abdominal pain in all cases. There were no postoperative complications. CONCLUSION: As a conclusion, thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, affording drug cessation and recovery of daily activity in most patients.
Abdominal Pain ; Anesthesia, General ; Catheters ; Humans ; Lung ; Pleura ; Postoperative Complications ; Splanchnic Nerves ; Thoracoscopy

Since it was first described by Kappis, celiac plexus neurolysis (CPN) has been performed under fluoroscopic guidance by anesthetists or surgeons for the relief of intractable pain caused by upper abdominal malignancy. Recently, however, several groups have reported a computed tomography (CT)-guided technique that increased the safety of the blocking procedure and improved its results. The authors present a new technique CT-guided celiac plexus and splanchic nerve block, to be used simultaneously with a modified anterior approach. Using CT to guide needle tip placement, an anterior approach that permitted direct neurolysis of the celiac ganglia and splanchnic nerve was developed.
Anesthesia ; Celiac Plexus* ; Ganglia, Sympathetic ; Needles ; Nerve Block ; Pain, Intractable ; Splanchnic Nerves*

AIMTo explore the cerebral cortex mechanism of visceral nociceptive sensation and its characteristics on the cell level, we investigated the membrane electrical properties of 176 stimulus-relative neurons of greater splanchnic nerve (GSN) in anterior cingulate gyrus (ACG) of 20 adult healthy cats.

METHODSWe used intracellular recording techniques of glass microelectrode and injected polarizing current into the neurons in ACG.

RESULTSAmong 176 neurons, 148 were visceral nociceptive neurons (VNNs) and 28 non-visceral nociceptive neurons (NVNNs). The membrane resistance (Rm), time constant (tau), membrane capacity (Cm), and the I-V curve of both VNNs and NVNNs in ACG were significantly different. The discharge frequency and amplitude of both VNNs and NVNNs produced by injecting depolarized current were different, too.

CONCLUSIONThe results suggest that structure of cell membrane, volume of the soma, and other aspects of morphology between VNNs and NVNNs in ACG may have significant differences. The results also might provide progressively experimental evidence for specific theory of pain sensation.

Animals ; Cats ; Gyrus Cinguli ; cytology ; physiology ; Membrane Potentials ; Nociceptors ; physiology ; Splanchnic Nerves ; physiology ; Visceral Afferents ; physiology

Pain of intraabdominal organ is transduced through splanchnic and sympathetic nerve. Mallet- Guy et al introduced the method of splanchnicectomy and lumbar sympathectomy for control of pain of pancreatitis and pancreatic cancer. It has been considered as an out-dated procedure because of the long surgical incisions and the development of celiac plexus block with long needles. However, as VATS was recently applied to many thoracic surgical fields, splanchnicotomy assisted by a thoracoscope is considered as a good method for intractable abdominal pain.
Abdominal Pain* ; Celiac Plexus ; Needles ; Pancreatic Neoplasms ; Pancreatitis ; Splanchnic Nerves ; Sympathectomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopes

PURPOSE: To investigate the inhibitory effect and possible mechanism of intraurethral stimulation on overactive bladder (OAB) induced by acetic acid irritation. METHODS: Cystometry was performed in 13 urethane-anesthetized female rats. Intravesical infusion of 0.5% acetic acid was used to irritate the bladder and induce OAB. Multiple cystometrograms were performed with mirabegron, continuous stimulation, mirabegron plus continuous stimulation, and beta3-adrenoceptor antagonist plus continuous stimulation to determine the mechanism underlying the inhibitory effect by intraurethral stimulation. RESULTS: Infusion of acetic acid significantly decreased bladder capacity. Intraurethral stimulation at 2.5 Hz plus mirabegron significantly increased bladder capacity and decreased the nonvoiding contraction count. The changes were strongly inhibited after the beta3-adrenoceptor antagonist was administered. CONCLUSIONS: Activation of urethral afferent nerves can reverse OAB, which activates C-fiber afferent nerves. This animal study indicates that intraurethral stimulation may interfere with OAB through hypogastric nerve activation and pudendal nerve neuromodulation.
Acetic Acid ; Animals ; Electric Stimulation ; Female* ; Humans ; Pudendal Nerve ; Rats* ; Splanchnic Nerves ; Urinary Bladder ; Urinary Bladder, Overactive*

PURPOSE: We wanted to study the precise anatomical location of the branches of the pelvic plexus from the sacral root to the cavernous nerve. MATERIALS AND METHODS: We performed microdissection on the pelvises from 4 male formalin fixed cadavers under a Zeiss surgical microscope and we traced the location of the branches of the pelvic plexus at a magnification of 6x. RESULTS: The configuration of the pelvic plexus was an irregular diamond shape rather than rectangular. It was located retroperitoneally on the lateral wall of the rectum 8.2 to 11.5cm from the anal verge. Its midpoint was located 2.0 to 2.5cm from the seminal vesicle posterosuperiorly. A prominent neurovascular bundle (NVB) was located on the posterolateral portion of the apex and the mid portion of the prostate. The pelvic splanchnic nerve (PSN) joined the NVB at a point distal and inferior to the bladder-prostate (BP) junction. The PSN components joined the NVB in a spray-like distribution at multiple levels distal to the BP junction. The distance from the membranous urethra to the NVB was 0.5 to 1.2cm. We also found multiple tiny branches on the anterolateral aspect of the prostate apex. CONCLUSIONS: In contrast to the usual concept, the NVB was much wider above the mid portion of the prostrate and it supplied multiple tiny branches on the anterolateral aspect of the prostate. The PSN branches arose from the more posteroinferior area of the pelvic plexus. Therefore, we recommend a more anterior dissection of the lateral pelvic fascia for nerve sparing radical prostatectomy. If surgeons plan a nerve graft after radical prostatectomy, they should consider this neuroanatomy for obtaining a successful outcome.
Cadaver ; Diamond ; Fascia ; Formaldehyde ; Humans ; Hypogastric Plexus* ; Male ; Microdissection ; Neuroanatomy ; Pelvis ; Prostate ; Prostatectomy ; Rectum ; Seminal Vesicles ; Splanchnic Nerves ; Transplants ; Urethra

PURPOSE: In patient with intractable abdominal pain due to cancer, with respect to the quality of life, it is often insufficient to relieve pain with the use of analgesics. The development of laparoscopic surgery has made a thoracoscopic splanchnicectomy possible, but the results by using several different methods have varied between different authors. Herein, we introduce a modified method of thoracoscopic splanchnicectomy on the basis of anatomical background from cadaver dissection. METHODS: Sixteen thoracoscopic splanchnicectomies were performed, with the Numerical rating scale (NRS) used for the assessment of pain. The procedure was performed, under general anesthesia, using a double lumen catheter to deflate the lung on the operation side with the patient in the lateral decubitus position. Openings were made in the 7th intercostal space at the postaxillary line for a 12 mm trocar and in the 4th and 5th intercostals spaces for 5 and 2 mm trocars, respectively. The terminal branch of the greater splanchnic nerve ends In 5th intercostal space. Six or seven branches of the splanchnic nerve were cut, dissected downward to just above the diaphragm and then cut. The sympathetic trunk was also cut in this level if the patient suffered from constipation. RESULTS: A splanchicectomy appeared to result in significant reduction of abdominal pain in all cases. The average reduction in the pain score was 78%. There were no postoperative complications. CONCLUSION: A thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, helping with drug cessation or the reduction and recovery of daily activity in most patients.
Abdominal Pain* ; Analgesics ; Anesthesia, General ; Cadaver ; Catheters ; Constipation ; Diaphragm ; Humans ; Laparoscopy ; Lung ; Postoperative Complications ; Quality of Life ; Splanchnic Nerves ; Surgical Instruments