Ultrasound-guided versus conventional fluoroscopic-guided superior hypogastric plexus block for cancer-related pelvic pain; a systematic review and meta-analysis | ||
| Egyptian Journal of Anaesthesia | ||
| Articles in Press, Accepted Manuscript, Available Online from 01 January 2025 | ||
| Document Type: Review Article | ||
| DOI: 10.21608/egja.2025.411246.1177 | ||
| Authors | ||
| Samar R Amin* 1; Elsayed M Abdelzeem1; Mohamed Said Elmeligy2; Fatma Ahmed Abdelfatah1 | ||
| 1Department of Anesthesia, intensive care, and pain management, Faculty of Medicine, Benha University. | ||
| 2Department of Anesthesia, intensive care, and pain management, Faculty of Medicine, Benha University | ||
| Abstract | ||
| Background: Chronic pelvic cancer pain is a major and distressing symptom. In addition to conventional treatments such as analgesics and surgical interventions, the superior hypogastric plexus block (SHPB) serves as an alternative option for managing severe pain. This study aimed to compare the outcomes of two imaging modalities—ultrasound and fluoroscopy—for guiding SHPB. Methods: A systematic search was conducted in PubMed, Cochrane Library, Web of Science, Scopus, and Elsevier ScienceDirect for randomized controlled trials (RCTs) published before May 2025. The effectiveness of ultrasound-guided and fluoroscopy-guided SHPB was compared in terms of pain intensity (primary outcome), morphine consumption, quality of life (QOL), patient satisfaction, procedure duration, and post-procedural complications. Subgroup analyses were performed based on different time-points. Results: The analysis included four RCTs involving 246 patients. No significant differences in pain relief were observed in one week, one month, two months, or three months between the ultrasound-guided and fluoroscopy-guided groups. However, the overall effect showed significantly lower pain scores in the ultrasound-guided group (SMD = -0.39, 95% CI [-0.70, -0.07], p = 0.02), with substantial heterogeneity (I² = 79%). No significant differences were found for morphine consumption, QOL, patient satisfaction, or procedure duration. Notably, the ultrasound-guided group had significantly fewer procedure-related complications (RR = 0.35, 95% CI [0.15, 0.81], p = 0.01), with moderate heterogeneity (I² = 46%). Conclusion: Ultrasound-guided SHPB was comparable to the conventional fluoroscopy-guided approach for long-term pain control and was associated with a lower risk of adverse effects. | ||
| Keywords | ||
| ultrasonography; fluoroscopy; pelvic cancer; pain management; meta-analysis | ||
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