Transdiscal vs Paravertebral Neurolytic Splanchnic Nerve Block for Upper Abdominal Cancer Pain

NCT07445386 | Recruiting

• 1 other identifier: Transdiscal vs Paravert SNB
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to compare the efficacy of fluoroscopy-guided paravertebral (PV) and transdiscal (TD) approaches for splanchnic nerve neurolysis in patients with upper abdominal cancer-related pain (e.g., gastric, pancreatic, and hepatic malignancies). Treatment response will be assessed using the Numerical Rating Scale (NRS), and the impact of both techniques on quality of life will be evaluated with the EORTC QLQ-C30 questionnaire.

Conditions

Cancer Pain

Keywords

Splanchnic Nerves; Nerve Block; Abdominal Pain; Pancreatic Neoplasms; Liver Neoplasms

Outcome Measures

Primary Outcomes (1)

• Numerical rating scale (NRS)

  NRS is a scale that can be used measuring pain. Scores range from 0 (no pain) to 10 (the worst pain)

  Change from baseline to post-treatment day 3, and at 1 and 3 months.

Secondary Outcomes (2)

• EORTC QLQ-C30 questionnaire

  Change from baseline to 1st and 3rd month after treatment

• Fluoroscopy imaging time

  During procedure

Study Arms (2)

transdiscal splanchnic neurolysis group

ACTIVE COMPARATOR

Transdiscal splanchnic neurolysis for upper gastrointestinal malignancy pain

Procedure: transdiscal splanchnic neurolysis

paravertebral splanchnic neurolysis group

ACTIVE COMPARATOR

Paravertebral splanchnic neurolysis for upper gastrointestinal malignancy pain

Procedure: paravertebral splanchnic neurolysis

Interventions

transdiscal splanchnic neurolysis PROCEDURE

With the patient in the prone position, the T11-T12 vertebral levels were identified under anteroposterior fluoroscopic guidance, and the C-arm was adjusted to align the superior and inferior endplates of the T11-T12 intervertebral disc. The fluoroscope was then rotated obliquely to position the tip of the T12 superior articular process at the midpoint of the T11 vertebral body. After local anesthesia with 2 mL of 1% lidocaine, a spinal needle was advanced to the target point. The ideal final needle position was at the center of the intervertebral disc on the anteroposterior view and at the anterior border of the vertebral body on the lateral view. Correct needle placement was confirmed fluoroscopically, followed by injection of 1-2 mL of nonionic contrast to verify appropriate retrocrural spread. After a successful test dose with 10 mL of 1% lidocaine resulting in \>50% pain relief, 10 mL of 96% alcohol was slowly injected for neurolysis.

transdiscal splanchnic neurolysis group

paravertebral splanchnic neurolysis PROCEDURE

Under C-arm fluoroscopic guidance, the inferior border of the T11 vertebral body was used as a reference, and the fluoroscope was adjusted to a 15-20° craniocaudal and approximately 15-20° oblique angle. The needle entry point was selected slightly inferior to the T11 transverse process, and after local anesthesia with 2 mL of 1% lidocaine, the spinal needle was advanced along the lateral aspect of the vertebral body. On lateral fluoroscopic view, the needle tip was positioned at the anterior two-thirds of the vertebral body. Correct needle placement was confirmed fluoroscopically, followed by negative aspiration and injection of 1-2 mL of nonionic contrast to verify appropriate retrocrural spread. After a successful test dose with 5 mL of 1% lidocaine resulting in \>50% pain relief, 5 mL of 96% alcohol was slowly injected for neurolysis. The same procedure was repeated contralaterally, resulting in a total of 10 mL of 96% alcohol.

paravertebral splanchnic neurolysis group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Severe abdominal pain (NRS \> 6) due to upper intra-abdominal organ malignancies (such as gastric, pancreatic, or hepatic cancer).
• Failure of pain control with conservative treatment modalities.

You may not qualify if:

• Presence of local anatomical variations
• Localized or systemic infection involving the procedural site
• Pregnancy
• Coagulopathy
• Presence of unstable psychiatric disorders

Sponsors & Collaborators

• Ankara Etlik City Hospital: lead

Study Sites (1)

Ankara Etlik City Hospital

Ankara, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Cancer Pain; Abdominal Pain; Pancreatic Neoplasms; Liver Neoplasms

Condition Hierarchy (Ancestors)

Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Signs and Symptoms, Digestive; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Endocrine Gland Neoplasms; Digestive System Diseases; Pancreatic Diseases; Endocrine System Diseases; Liver Diseases

Study Officials

• Gokhan Yildiz

  Ankara Etlik City Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Gokhan Yildiz

CONTACT

5059272589; gkoyldz@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Supervisor Investigator

Study Record Dates

• First Submitted: February 22, 2026
• First Posted: March 3, 2026
• Study Start: February 16, 2026
• Primary Completion (Estimated): August 16, 2026
• Study Completion (Estimated): September 16, 2026
• Last Updated: March 3, 2026

Record last verified: 2026-02

Locations

TU (1)