Splanchnic Nerve Neurolysis: Double Access for Abdominal Cancer Pain

Dear Editor The sympathetic innervation of the abdominal viscera is formed from the ventral branches of levels T5–T12. From these branches, the greater, lesser and least splanchnic nerves are formed, to finally synapse at the coeliac plexus. These branches innervate the distal oesophagus, transverse colon, pancreas, liver, adrenal glands and ureters and regulate the abdominal blood supply.1 This explains the efficacy of splanchnic nerve block in patients with upper abdomen and lower oesophageal neoplasms. Plancarte et al reported a significant improvement in pain levels and reduction of painkillers intake in 109 patients with upper abdomen and lower oesophageal neoplasms, administering 8–10 mL of 10% phenol in the retrocrural and retroaortic space, using a single-needle, posterior transdiscal approach, guided by CT scan.2 Over time, several techniques for splanchnic nerve block have been described, either guided by CT scan or fluoroscopy, administering volumes even greater than 10 mL …