A Novel Technique of Saddle Rhizotomy Using Thermal Radiofrequency for Intractable Perineal Pain in Pelvic Malignancy: A Pilot Study

• Published in: Pain physician 2018-11, Vol.21 (6), p.E651-E660
• Main Authors: Reyad, Raafat M, Hakim, Sameh M, Abbas, Dina N, Ghobrial, Hossam Z, Mansour, Ekramey
• Format: Article
• Language: English
• Subjects: Ablation; Adolescent; Adult; Cancer Pain - etiology; Cancer Pain - surgery; Female; Humans; Male; Middle Aged; Pain; Pain Management - methods; Pain, Intractable - etiology; Pain, Intractable - surgery; Patient satisfaction; Pelvic Neoplasms - complications; Pelvic Pain - etiology; Pelvic Pain - surgery; Phenols; Pilot Projects; Radiofrequency Ablation - methods; Rhizotomy - methods
• ISSN: 1533-3159; 2150-1149

The prevalence of pain in advanced pelvic cancer may reach up to 95%. Control of such pain is often difficult owing to a variety of neuroanatomical and functional peculiarities. Different modalities have been utilized to treat this pain including saddle chemical rhizolysis with the potential for jeopardizing the neural control of the sphincters. The aim of this pilot study is to determine the feasibility of using selective thermal radiofrequency as an alternative to saddle chemical rhizolysis in patients with refractory perineal pain associated with pelvic malignancies. Pilot study. Pain Relief Department of the National Cancer Institute, Cairo University. Forty patients, 18 years of age or older, who had pelvic malignancy and were complaining of moderate or severe perineal pain not controlled with maximum tolerable doses of morphine sulfate for at least 4 weeks were randomly allocated to receive selective saddle rhizotomy using thermal radiofrequency ablation of S3 on one side and bilateral ablation of S4 and S5 (RF group, n = 20) or conventional chemical rhizotomy using hyperbaric 6% phenol in glycerin (Phenol group, n = 20). Patients were assessed for the intensity of pain, daily consumption of analgesics, functional improvement, overall patient satisfaction, degree of disability and occurrence of procedure-related side effects at 1,4, and 12 weeks. The results were comparable in both groups regarding the control of pain and functional improvement. The incidence of specific procedure-related adverse outcomes was also equivalent for both interventions, although per-patient incidence of major complications was significantly higher in the phenol group. Small sample size to demonstrate statistical significance of the relatively small frequency of events, and the patients could not be blinded to the intervention they received owing to the technical uniqueness of either intervention. Selective thermal radiofrequency ablation of the S3 root on one side, S4 root on both sides, and S5 roots could serve as a feasible alternative to conventional saddle rhizotomy using hyperbaric phenol. Perineal cancer pain, chemical rhizotomy, thermal radiofrequency.