Neurolytic Sympathectomy in the Management of Cancer Pain –Time Effect. A Prospective, Randomized Multicenter Study

• Yasser M. Amr, MD^{1, ,} ,
• Mohamed Y. Makharita, MD²

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Abstract

Context.

Sympathectomy is currently used as the fourth step of the modified World Health Organization (WHO) analgesic ladder. Sympathectomy can performed early, before the second on the ladder.

Objectives

We hypothesized that early sympathectomy would reduce pain and opioid consumption and improve quality of life.

Methods

One hundred nine patients, with inoperable abdominal or pelvic cancer, reporting visceral pain of 40 to 70 on a visual analogue scale (VAS) and taking nonopioid analgesics, were allocated randomly into two groups; either blocks were performed before step 2 of the WHO ladder and then analgesics were managed according to the ladder (Group I), or analgesics were given according to the WHO ladder and blocks were performed as the fourth step after failure of strong opioids to control pain (Group II). VAS scores, responder analysis, daily opioid consumption, related side effects and quality of life were assessed.

Results

Responders were significantly higher in Group I (P <0.0001), and partial responders and non-responders significantly increased in Group II (P <0.0001, 0.006, respectively). 

Opioid consumption significantly decreased in Group I (P <0.0001 during first 12 months and 0.007 at the last assessment time), with concomitant significant reduction in related side effects. The number of patients who had a good analgesic response on tramadol significantly increased in Group I during the first five months (P <0.05). QLQ-C30 global quality of life subscale scores revealed significant improvement until the fifth month in Group I (P < 0.05).

Conclusion

Sympathectomy before step 2 on the WHO analgesic ladder seems to lead to better pain control, less opioid consumption and better quality of life in cancer patients.