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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT05427058
Other study ID # UB_WWN01
Secondary ID
Status Not yet recruiting
Phase N/A
First received
Last updated
Start date August 1, 2022
Est. completion date April 30, 2023

Study information

Verified date June 2022
Source University of Brawijaya
Contact Ristiawan Muji Laksono, MD,FIPP
Phone +6281233773593
Email ristiawanm@ub.ac.id
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study compared the efficacy and safety of superior hypogastric plexus block and ganglion impar block procedures on the management of pelvic and perineal cancer pain in patients with cervical and endometrial cancer


Description:

Superior hypogastric plexus block is a commonly used method for the management of pelvic and perineal pain due to cancer, this procedure uses a transdiscal approach at the level of the L5-S1 vertebrae by injecting 5 ml of 1% lidocaine + 10 ml of 96% alcohol and confirmed by C-arm. Compared with the ganglion impar block procedure using a trans-sacrococcygeal approach by injecting 4 ml of 1% lidocaine + 6 ml of 96% alcohol and confirmed by C-arm. The aim of this study was to compare the efficacy and safety of the ganglion impar block procedure against the superior hypogastric plexus block which is commonly used in the management of pelvic and perineal pain due to cervical and endometrial cancer.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 36
Est. completion date April 30, 2023
Est. primary completion date January 30, 2023
Accepts healthy volunteers No
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria: - Unbearable cancer pain that is resistant to WHO (World Health Organization) pain ladder at least 2 weeks medication - The patient is tired of taking medication orally or complications of current medication (respiratory depression, nausea, vomiting, opioid-induced constipation, gastrointestinal disturbances) - Patients with pelvic floor pain diagnosed by a (Fellow of Interventional Pain Practice) FIPP-certified pain specialist - Patients with pain in the perineum diagnosed by a FIPP-certified pain specialist - Numerical Rating Scale >4 - >18 years old - Able and willing to sign an informed consent Exclusion Criteria: - Refuse to be included in the research - Blood clotting disorders (including taking anticoagulant drugs) - Local infection in the area of action - Loss to follow up Drop-out Criteria: - Loss to follow up - Intervention complications occur - Failed intervention

Study Design


Intervention

Procedure:
Superior Hypogastric Plexus Block
this procedure uses a transdiscal approach at the level of the L5-S1 vertebrae by injecting 5 ml of 1% lidocaine + 10 ml of 96% alcohol and confirmed by C-arm.
Ganglion Impar Block
this procedure uses a trans-sacrococcygeal approach by injecting 4 ml of 1% lidocaine + 6 ml of 96% alcohol and confirmed by C-arm.

Locations

Country Name City State
n/a

Sponsors (1)

Lead Sponsor Collaborator
University of Brawijaya

References & Publications (42)

Ahmed DG, Mohamed MF, Mohamed SA. Superior hypogastric plexus combined with ganglion impar neurolytic blocks for pelvic and/or perineal cancer pain relief. Pain Physician. 2015 Jan-Feb;18(1):E49-56. — View Citation

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Gamal G, Helaly M, Labib YM. Superior hypogastric block: transdiscal versus classic posterior approach in pelvic cancer pain. Clin J Pain. 2006 Jul-Aug;22(6):544-7. — View Citation

Gonnade N, Mehta N, Khera PS, Kumar D, Rajagopal R, Sharma PK. Ganglion impar block in patients with chronic coccydynia. Indian J Radiol Imaging. 2017 Jul-Sep;27(3):324-328. doi: 10.4103/ijri.IJRI_294_16. — View Citation

Gunduz OH, Kenis-Coskun O. Ganglion blocks as a treatment of pain: current perspectives. J Pain Res. 2017 Dec 14;10:2815-2826. doi: 10.2147/JPR.S134775. eCollection 2017. Review. — View Citation

Hochberg U, Minerbi A, Boucher LM, Perez J. Interventional Pain Management for Cancer Pain: An Analysis of Outcomes and Predictors of Clinical Response. Pain Physician. 2020 Sep;23(5):E451-E460. — View Citation

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Leslie KK, Thiel KW, Goodheart MJ, De Geest K, Jia Y, Yang S. Endometrial cancer. Obstet Gynecol Clin North Am. 2012 Jun;39(2):255-68. doi: 10.1016/j.ogc.2012.04.001. — View Citation

Mishra S, Bhatnagar S, Gupta D, Thulkar S. Anterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain. Anaesth Intensive Care. 2008 Sep;36(5):732-5. — View Citation

Mohamed SA, Ahmed DG, Mohamad MF. Chemical neurolysis of the inferior hypogastric plexus for the treatment of cancer-related pelvic and perineal pain. Pain Res Manag. 2013 Sep-Oct;18(5):249-52. Epub 2013 May 28. — View Citation

Nicholas M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, Cohen M, Evers S, Giamberardino MA, Goebel A, Korwisi B, Perrot S, Svensson P, Wang SJ, Treede RD; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019 Jan;160(1):28-37. doi: 10.1097/j.pain.0000000000001390. Review. — View Citation

Oliveira KG, von Zeidler SV, Podestá JR, Sena A, Souza ED, Lenzi J, Bissoli NS, Gouvea SA. Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy. BMC Cancer. 2014 Jan 24;14:39. doi: 10.1186/1471-2407-14-39. — View Citation

Phedy P, Djaja YP, Tobing SDAL, Gatam L, Librianto D, Fachrisal, Gatam AR, Hardiansyah NP. Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oswestry Disability Index. Eur Spine J. 2021 Apr;30(4):1053-1062. doi: 10.1007/s00586-020-06690-3. Epub 2021 Jan 2. — View Citation

Prabhu M, Eckert LO. Development of World Health Organization (WHO) recommendations for appropriate clinical trial endpoints for next-generation Human Papillomavirus (HPV) vaccines. Papillomavirus Res. 2016 Dec;2:185-189. doi: 10.1016/j.pvr.2016.10.002. Epub 2016 Oct 26. — View Citation

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Rocha A, Plancarte R, Nataren RGR, Carrera IHS, Pacheco VALR, Hernandez-Porras BC. Effectiveness of Superior Hypogastric Plexus Neurolysis for Pelvic Cancer Pain. Pain Physician. 2020 Mar;23(2):203-208. — View Citation

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Schultz DM. Inferior hypogastric plexus blockade: a transsacral approach. Pain Physician. 2007 Nov;10(6):757-63. — View Citation

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Tunio M, Al Asiri M, Bayoumi Y, Abdullah O Balbaid A, AlHameed M, Gabriela SL, Amir O Ali A. Lumbosacral plexus delineation, dose distribution, and its correlation with radiation-induced lumbosacral plexopathy in cervical cancer patients. Onco Targets Ther. 2014 Dec 23;8:21-7. doi: 10.2147/OTT.S71086. eCollection 2015. — View Citation

Turker G, Basagan-Mogol E, Gurbet A, Ozturk C, Uckunkaya N, Sahin S. A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach. Tohoku J Exp Med. 2005 Jul;206(3):277-81. — View Citation

van den Beuken-van Everdingen MH, de Graeff A, Jongen JL, Dijkstra D, Mostovaya I, Vissers KC; national guideline working group "Diagnosis treatment of cancer pain". Pharmacological Treatment of Pain in Cancer Patients: The Role of Adjuvant Analgesics, a Systematic Review. Pain Pract. 2017 Mar;17(3):409-419. doi: 10.1111/papr.12459. Epub 2016 May 21. Review. — View Citation

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* Note: There are 42 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Numerical rating scale (NRS) Used to measure pain relief with a value of 0-10 (0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, 7-9 = severe pain, 10 = most severe pain). The average pain intensity felt by the patient in the last 1 week 3 month
Primary Oswestry Disability Index (ODI) The Oswestry Disability Index is a measuring tool to evaluate the quality of life and the level of disability. In this study, we will use the Indonesian adaptation version. in a journal published by Phedy et al showed that the Indonesian version of the ODI retains the reliability, validity, and psychometric characteristics of the original ODI.
There are 10 main questions with 6 assessment options from the lowest point of 0 and the highest point of 5.
0-20%: mild disability 21-40%: moderate disability, affecting activities can still be overcome 41-60%: severe disability, pain is a major problem and interferes with activities 61-80%: patients experience disturbances in major aspects of life requiring intervention 81-100%: the patient is confined to bed because of complaints
3 Month
Primary Morphine equivalent daily dose (MEDD) This is the dose that the patient takes regularly to relieve pain. 3 Month
Secondary Adverse effect It is an unwanted effect due to the intervention given to the patient. 3 Month
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