Ultrasound versus Fluoroscopic-Guided Superior Hypogastric Plexus Block in Cancer Bladder: A Randomized Controlled Trial

Abstract

BACKGROUND: Patients with advanced bladder cancer may suffer severe pelvic pain unresponsive to standard pharmacological therapy. AIM: This study assessed the feasibility, efficacy of ultrasoundguided (USG) versus fluoroscopy-guided (FG) superior hypogastric plexus block (SHPB) in bladder cancer pain management. METHODS: This randomized controlled study included 60 patients undergoing SHPB to manage pain in stages 3 and 4 bladder cancer patients from December 2020 to June 2021. They were randomly divided into two groups. Group Fluoro (n = 30) underwent FG-SHPB, while Group US (n = 30) underwent US-SHPB. The patients were assessed after 1 day and 1 and 3 months regarding pain intensity using visual analog score (VAS), daily morphine consumption, functional capacity, and quality of life (QoL) using the Short Form Health Survey-36. RESULTS: The procedure failed in 2 patients in each group. The procedure was significantly lengthier in the Fluor group than the US group (p < 0.001). VAS scores decreased significantly in the two groups after 1 and 3 months and were significantly in US-SHBP after 3 months. Morphine consumption decreased significantly, and functional capacity and QoL improved significantly in both groups up to 3 months. The two groups were comparable in morphine consumption, functional capacity, and QoL. Position discomfort and back pain were more common in Fluor Group. CONCLUSION: USG SHPB is a feasible, safe, and effective analgesic procedure in patients with advanced bladder cancer suffering from severe pelvic pain. It is superior to the FG transdiscal approach regarding the duration of pain relief and improvement of functional capacity in addition to avoidance of position discomfort and back pain. REGISTRATION: Clinical Trials.gov (ID NCT05083702).