Differences in intravaginal ejaculation latency reflect normal biological variation, but the causes are poorly understood. Here, we investigated whether variation in ejaculation latency in an experimental rat model is related to altered sympathetic nervous system (SNS) activity and expression of N-methyl-D-aspartic acid (NMDA) receptors in the paraventricular nucleus of the hypothalamus (PVN). Male rats were classified as "sluggish," "normal," and "rapid" ejaculators on the basis of ejaculation frequency during copulatory behavioral testing. The lumbar splanchnic nerve activity baselines in these groups were not significantly different at 1460 ± 480 mV, 1660 ± 600 mV, and 1680 ± 490 mV, respectively (P = 0.71). However, SNS sensitivity was remarkably different between the groups (P < 0.01), being 28.9% ± 8.1% in "sluggish," 48.4% ± 7.5% in "normal," and 88.7% ± 7.4% in "rapid" groups. Compared with "normal" ejaculators, the percentage of neurons expressing NMDA receptors in the PVN of "rapid" ejaculators was significantly higher, whereas it was significantly lower in "sluggish" ejaculators (P = 0.01). In addition, there was a positive correlation between the expression of NMDA receptors in the PVN and SNS sensitivity (r = 0.876, P = 0.02). This study shows that intravaginal ejaculatory latency is associated with SNS activity and is mediated by NMDA receptors in the PVN.
Animals ; Copulation ; Ejaculation/physiology* ; Female ; Male ; Neurons/physiology* ; Paraventricular Hypothalamic Nucleus/physiology* ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate/metabolism* ; Sexual Behavior, Animal/physiology* ; Splanchnic Nerves/physiology* ; Sympathetic Nervous System/physiology*

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD.
Abdominal Pain ; Analgesics, Opioid ; Cholecystectomy ; Humans ; Nerve Block ; Pancreatitis ; Sphincter of Oddi Dysfunction* ; Spinal Cord Stimulation* ; Splanchnic Nerves ; Visceral Pain* ; Visual Analog Scale

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*

BACKGROUND: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. METHODS: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. RESULTS: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. CONCLUSIONS: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.
Abdominal Pain ; Analgesia ; Autonomic Nerve Block ; Celiac Plexus* ; Follow-Up Studies* ; Gastrointestinal Neoplasms ; Humans ; Needles ; Nerve Block ; Pain Measurement ; Quality of Life* ; Surveys and Questionnaires ; Splanchnic Nerves* ; Survival Rate ; Tramadol ; Treatment Outcome ; Upper Gastrointestinal Tract* ; Visceral Pain ; Weights and Measures

To determine the proportion of nerve fibers in the hypogastric nerve (HGN) and pelvic splanchnic nerve (PSN), small tissue strips of the HGN and PSN from 12 donated elderly cadavers were examined histologically. Immunohistochemistry for neuronal nitric oxide synthase (NOS), vasoactive intestinal peptide (VIP), and tyrosine hydroxylase (TH) was performed. More than 70% of fibers per bundle in the HGN were positive for TH at the level of the sacral promontory. In addition, NOS- (negative) and/or VIP+ (positive) fibers were observed in small areas of each nerve bundle, although the proportion of each was usually less than 10%. In the PSN near the third sacral nerve root, the proportion of nerve fibers positive for NOS and/or VIP (or TH) was below 30%. In both the HGN and PSN, the number of VIP+ fibers was usually greater than that of NOS+ fibers, with frequent co-localization of NOS and VIP. More fibers in both nerves were positive for TH than for these other markers. In contrast to pelvic plexus branches, there were no differences in the proportions of NOS+ and VIP+ fibers between nerve bundles in each of the tissue strips. Thus, target-dependent sorting of nerve fibers was not apparent in the HGN at the level of the sacral promontory or in the PSN near the third sacral nerve root. The NOS+ and/or VIP+ fibers in the HGN were most likely ascending postganglionic fibers to the colon, while those in the PSN root may be preganglionic fibers from Onuf's nucleus.
Aged* ; Cadaver* ; Colon ; Humans ; Hypogastric Plexus ; Immunohistochemistry ; Nerve Fibers* ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I ; Splanchnic Nerves* ; Tyrosine 3-Monooxygenase ; Vasoactive Intestinal Peptide

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

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

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*

AIMTo study the effect of atropine, muscarinic cholinergic antagonist, on the central analgesic action of melatonin (MT) and to explore the mechanism of MT analgesia.

METHODSAs an indicator of visceral pain, the unit discharges of the neurons in the posterior group of thalamic nuclei (PO) were caused by stimulating the great splanchnic nerve (GSN) of the cat. The cranial stereotaxic and extracellular glass microelectrode record technique were used. The drugs were given through the intra-cranial-ventricle (icv).

RESULTS0.1% MT (10 micrograms.kg-1, icv) was shown to inhibit the unit discharge of the neurons in PO of the cat, whether the long latency or the short latency, which was evoked by stimulating GSN. The inhibition of 0.1% MT (10 micrograms.kg-1, icv) on the short latency discharge of neurons in PO was antagonized by 0.1% atropine (20 micrograms, icv). However, 0.1% atropine (20 micrograms, icv) did not show antagonistic effect on the inhibition of 0.1% morphine (5 micrograms, icv) at the same latency.

CONCLUSIONMT exhibited central analgesic action with mechanism different from morphine. It was suggested that the cholinergic system may be involved in analgesic process of MT.

Analgesics ; administration & dosage ; pharmacology ; Animals ; Atropine ; pharmacology ; Cats ; Electric Stimulation ; Evoked Potentials ; drug effects ; Female ; Injections, Intraventricular ; Male ; Melatonin ; administration & dosage ; pharmacology ; Morphine ; pharmacology ; Muscarinic Antagonists ; pharmacology ; Neurons ; physiology ; Splanchnic Nerves ; physiology ; Thalamic Nuclei ; drug effects ; physiology