Research Summary

Transdiscal Splanchnic Nerve Block Provides Simplified Approach to Pain Relief in Advanced Pancreatic Cancer

Miranda Manier, BA

Key Highlights

  • In a randomized controlled trial of 34 patients with advanced pancreatic cancer pain, both transdiscal and paraspinal splanchnic nerve block approaches significantly reduced pain.
  • The transdiscal approach required shorter puncture time and fewer fluoroscopy exposures compared with the paraspinal approach.
  • Pain relief, patient satisfaction, functional status, and complication rates were similar between groups.
  • The transdiscal technique was found to be simpler and more accurate, suggesting it may be the preferred approach.

A randomized controlled clinical trial comparing the transdiscal and paraspinal approaches for splanchnic nerve block in patients with advanced pancreatic cancer pain found that both approaches provide effective analgesia, with the transdiscal approach offering technical advantages including shorter procedure time and reduced fluoroscopy exposure.

Pain is a frequent and severe complication of advanced pancreatic cancer, often requiring multimodal management to reduce suffering and improve quality of life. Splanchnic nerve block is a recognized interventional technique to control refractory pain in these patients. While both paraspinal and transdiscal approaches are used in clinical practice, comparative evidence on their relative effectiveness, safety, and technical feasibility has been limited. This study aimed to directly evaluate these two approaches.

A total of 34 patients with progressive pancreatic cancer pain treated at the Pain Department of the First Affiliated Hospital of Nanchang University between December 2021 and March 2023 were enrolled. Patients were randomized equally into a transdiscal group (n = 17) and a paraspinal group (n = 17). Data collected included puncture time, number of digital subtraction angiography fluoroscopy exposures, pain intensity measured with the Visual Analogue Scale (VAS), patient satisfaction, functional status using the Karnofsky score, morphine consumption, and adverse events. Assessments were performed at baseline and at multiple postoperative time points up to 3 months.

Follow-up was completed in 14 patients in the transdiscal group and 15 in the paraspinal group. Baseline characteristics were comparable between groups. The transdiscal group demonstrated significantly shorter puncture times and required fewer fluoroscopy exposures than the paraspinal group (P < .001). Both groups experienced marked reductions in VAS pain scores at all postoperative time points compared with preoperative values (P < .001). However, there were no significant differences between groups in VAS scores, patient satisfaction, or Karnofsky scores at any time point. Morphine use was reduced after the procedure in both groups. Rates of complications did not differ significantly between groups.

 “Splanchnic nerve block paraspinal had a significant effect on the treatment of advanced pain in pancreatic cancer patients,” Luo and colleagues concluded. “However, transdiscal is equally effective, the positioning is more accurate, the operation is simpler, and it is a better choice.”

Reference
Luo L, Cao X, Qiu M, Zhu M, Yan Y, Zhang D, Zhang X. Splanchnic nerve block via transdiscal and paraspinal approach in the treatment of pain in advanced pancreatic cancer: A randomized controlled trial. Medicine (Baltimore). 2025;104(38):e44250. doi:10.1097/MD.0000000000044250