Clinical Observation Of Splanchnic Nerve Block Via Transdiscal And Paraspinal Approach In The Treatment Of Pain In Advanced Pancreatic Cancer

Objective: A randomized controlled study was conducted to compare the clinical efficacy of splanchnic nerve block via transdiscal and paraspinal approach in the treatment of advanced pancreatic cancer pain,and the intraoperative puncture time and exposure times of digital subtraction radiography system Digital subtraction angiography(DSA)were recorded to provide reference for clinical application.Methods: This study was a randomized controlled clinical trial.Patients with advanced pancreatic cancer pain admitted to the pain department of The First Affiliated Hospital of Nanchang University from January 2021 to September 2022 were selected.According to the inclusion and exclusion criteria,a total of 34 patients were randomly divided into two groups: transdiscal group(n=17)and paravertebral group(n=17).DSA guided splanchnic nerve block was performed respectively.The duration of intraoperative puncture time,the exposure times of DSA fluoroscopy and the visual analogue scale(VAS)scores of 1 day before operation and 1 day,3 days,1week,1 month and 3 months after operation were compared between the two groups,so as to evaluate the curative effect and record the related complications.Results: 14 patients were followed up in transdiscal approach group and 15 patients were followed up in paravertebral approach group.There was no significant difference in the general condition between the two groups before operation.In the transdiscal approach group,the puncture time was 32.29±5.92 min while the number of fluoroscopies was 9.77±1.52.In the paravertebral approach group,the puncture time was 45.12±7.84 min while the number of fluoroscopies was 14.00±2.62.There were significant differences in intraoperative puncture time and DSA exposure times between the two groups(P<0.05).The puncture time and number of fluoroscopies in the transdiscal approach group were significantly lower compared with those in the paraspinal approach group.There was no significant difference in VAS score between the two groups at each time point after operation(P>0.05).In the same group,the VAS scores at each time point after operation were significantly lower than those before operation,and the difference was statistically significant(P<0.05).In the transdiscal group,there were 3 cases of severe back pain,1 cases of hypotension and 2 cases of diarrhea.the incidence of complications was 42.9%(6/14).In the paravertebral approach group,there were 2 cases of severe back pain and 3 cases of diarrhea.The incidence of complications was 33.3%(5/15).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion: Transdisc approach and paraspinal approach are equally effective in the treatment of advanced pancreatic cancer pain,but the puncture time and exposure times in the transdiscal approach group are significantly less than those in the paraspinal approach group.Transdisc puncture approach is safe,less affected by tumor invasion,not blocked by thoracic transverse process,wider indications and better tolerance of patients,which is worthy of clinical promotion.