ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND
Volume 4. MARCH 1949. No. 3
THE SURGICAL RELIEF OF ABDOMINAL, PAIN BY SPLANCHNIC BLOCK
by Professor Dr. Miguel López Esnaurrízar, México.
SOMETIME AGO I delivered a lecture on this subject before The Mexican Academy of Surgery, as for many years I have been convinced that splanchnic block will releive the pain due to various abdominal colics, cancer of various abdominal organs, peptic ulcer, &c.
I have aIso recently, with the encouragement of my South American colleagues, embodied my observations and published thenl them in a book entitled Dolores Mortales.
I was so imbued with the efficacy of this treatment that I determined to visit England to give the results of this procedure to the College of Surgeons in the hope that the method might be more widely known and tried.
Although the method has been adopted by many surgeons in South America, I will relate only my own personal experiences.
General Considerations
A recognised method of studying the function of any organ is to interfere with, and, if possible destroy, the nerve supply. Any resulting abnormality can then be noted.
This can be done, at any rate temporarily for as long as eight weeks -and, occasionally permanently- by carrying out a paravertebral splanchnic block. with novocaine-alcohol* on each side.
THE SURGICAL RELIEF OF ABDOMINAL PAIN BY SPLANCHNIC BLOCK
I have repeatedly convinced myself and demonstrated to others that pain impulses are conducted along the splanchnic nerves, from the thoracic and abdominal organs. Such paln is immediately relieved when these nerves are blocked, e.g., the pain due to peptic ulcer.
Leriche and Dogliotti claim to have temporarily relieved the symptoms of diabetes mellitus by this procedure.
It is a well-known fact that the pain of varicose ulcers and also that due to endarteritis in the lower extremities is relieved by the vasodilatation produced by sympathectomy. It occurred to me that perhaps the function of abdominal organs such as the pancreas, intestine, kidney, &c., might be improved by the vascular dilatation produced by splanchnic block.
I believe that splanchnic block will relax any muscular spasm in the digestive, alimentary, biliary and urinary tracts, and aIso in the coronary arteries.
lt is a common experience for all clinicians to see patients who complain of severe epigastric pain, but in whom no signs indicative of the organ affected can be elicited.
These cases must be regarded as being due to somatic disease.
Such a case, which was completely relieved by splanchnic block, was the first which aroused my interest in this method of treatment. lt is recorded in full in Doloes Mortales. Since then I have had many similar cases treated successfully.
The lecturer then gave details of the various clinical conditions for which he had used splanchnic block with success. He pointed out the necessity of keeping all cases under observation as the relief might only be temporary.
Some of the case; had been diagnosed by the lecturer as acute pancreatitis. He reported that the exqllisitt pain in these cases had been completely controlled the subsequent history being such that he thought thc function of the pancreas had been improved by the vascular dilatation. He maintained that cases of peptic ulcer had been enabled to continue at their occupation, whereas by any other method they would have had to give up their work or seek relief by surgical interference.
Details were given of cases of diabetes mellitus treated by this method. The glycosuria disappeared and the blood sugar became normal. Though relapses may follow dietary indiscretions, these can be corrected by a further splanchnic block.
The pain due to inoperable cancer is likewise relieved, and the patient has a painless termination to the disease.
He has used this method of treatment extensively for hypertension, but in this disease it must be repeated, as symptoms reappear usually at intervals of approximately two months.
He has even known cases of the most obstinate constipation, on which the usual purgatives had very little effect, relieved by regular injections of novocaine-alcohol into the paravertebral tissue.
Cases of renal colic and hydronephrosis in which no calculus is present are benefited by this treatment in a marked degree Technique.
The injections are given in the prone position. The usual dose is 10 cc. given into each side.
Admission to hospital for a few days is desirable as a severe neuritis may develop due to involvement of the posterior nerve roots. If the patient complains of pain in the lower limbs during the injection, then it must be stopped. Any local neuralgia which results from the treatment can be relieved by diathermy.
The treatment is more efective in the obese than the thin.
* The lecturer did not state the composition of this solution.
Summary
A series of cases of abdominal pain treated by splanchnic block has been recorded. They are too few in number from which to draw definite conclusions.
Published by
THE ROYAL COLLEGE OF SURGEONS OF ENGLAND
LINCOLN'S INN FIELDS LONDON, W.C.2
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