Sympathetic blocks for visceral cancer pain management: A systematic review and EAPC recommendations

• An evidence-based assessment of sympathetic blocks for abdominal cancer patients showed that the quality of these studies was generally poor due to several limitations.
• Celiac plexus block, regardless of the technique used, improved analgesia and/or decrease in opioid consumption, and decreased opioid–induced adverse effects in comparison with a conventional analgesic treatment, as confirmed by two studies of good quality.
• Superior hypogastric plexus block determined a decrease in pain intensity and a less morphine consumption in one study.
• On the basis of existing evidence, CPB has a strong recommendation in patients with pancreatic cancer pain, while there is a weak recommendation for superior hypogastric plexus block that should be based on individual conditions.

The neurolytic blocks of sympathetic pathways, including celiac plexus block (CPB) and superior hypogastric plexus block (SHPB) , have been used for years. The aim of this review was to assess the evidence to support the performance of sympathetic blocks in cancer patients with abdominal visceral pain. Only comparison studies were included. All data from the eligible trials were analyzed using the GRADE system. Twenty-seven controlled studies were considered. CPB, regardless of the technique used, improved analgesia and/or decrease opioid consumption, and decreased opioid–induced adverse effects in comparison with a conventional analgesic treatment. In one study patients treated with superior hypogastric plexus block (SHPB) had a decrease in pain intensity and a less morphine consumption, while no statistical differences in adverse effects were found. The quality of these studies was generally poor due to several limitations, including sample size calculation, allocation concealment, no intention to treat analysis. However, at least two CPB studies were of good quality. Data regarding the comparison of techniques or other issues were sparse and of poor quality, and evidence could not be analysed. On the basis of existing evidence, CPB has a strong recommendation in patients with pancreatic cancer pain. There is a weak recommendation for SHPB, that should be based on individual conditions. Data regarding the choice of the technique are sparse and unfit to provide any recommendation.