Percutaneous splanchnic nerve neurolysis analgesic efficacy and safety for cancer-related pain: a systematic review and meta-analysis.

Purpose: To perform a systematic review and meta-analysis of publications to evaluate the analgesic efficacy and safety of percutaneous splanchnic nerve neurolysis (SNN) for cancer-related pain.
Methods: We searched PubMed, Cochrane Library, and Ichushi-Web for English or Japanese articles published up to July 2022 and reporting patients who underwent percutaneous SNN for cancer-related pain. The outcome measures assessed in the systematic review and meta-analysis were the pain measurement scales and morphine equivalents daily dose (MEDD) before and after the intervention and the rate of complications.
Results: Pooled pain measurement scores at pre-intervention, 1-2 weeks, and at 1, 2, 3, and 6 months post-intervention were 6.65 (95% confidence interval [CI], 5.77-7.67, I ²  = 97%), 2.79 (95% CI, 2.00-3.88, I ²  = 88%), 2.82 (95% CI, 2.49-3.20, I ²  = 55%), 2.86 (95% CI, 2.64-3.10, I ²  = 0%), 2.99 (95% CI, 2.56-3.46, I ²  = 82%), and 3.09 (95% CI, 1.44-6.65, I ²  = 70%), respectively. Mean MEDD was described in 8 of the 11 included articles. In all 8 articles, MEDD decreased up to 3 months post-intervention. The pooled minor complication rates for diarrhea and hypotension were 28% (95% CI, 13-49%, I ²  = 85%) and 31% (95% CI, 16-51%, I ²  = 80%), respectively. The pooled major complication rate was 2% (95% CI, 1-2%, I ²  = 0%).
Conclusions: Analysis indicates that percutaneous SNN for cancer-related pain can be performed safely with sustained reduction of pain measurement scales while reducing the administration of opioids.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)