Interventional pain treatments for cancer pain

Annals of the New York Academy of Sciences

Volumn 1138, Issue , 2008, Pages 299-328

  Christo, Paul J ^a   Mazloomdoost, Danesh ^a  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Analgesia; Cancer; Epidural; External epidural catheter; External intrathecal catheter; Implantable drug delivery systems; Infusion therapies; Intrathecal; Intrathecal pumps; Nerve blocks; Neuraxial therapies; Opioids; Pain; Pain pumps; Programmable pumps

Indexed keywords

ANALGESIC AGENT; BACLOFEN; BUPIVACAINE; BUPRENORPHINE; CLONIDINE; DEXMEDETOMIDINE; FENTANYL; HYDROMORPHONE; LIDOCAINE; LOCAL ANESTHETIC AGENT; MORPHINE; OMEGA CONOTOXIN MVIIA; OPIATE DERIVATIVE; ROPIVACAINE; SUFENTANIL; TETRACAINE;

ADJUVANT THERAPY; ANALGESIA; CANCER PAIN; CANCER PALLIATIVE THERAPY; CELIAC PLEXUS; CLINICAL TRIAL; COGNITIVE DEFECT; CONFERENCE PAPER; CONFUSION; CONSCIOUSNESS DISORDER; CONSTIPATION; COST EFFECTIVENESS ANALYSIS; DELIRIUM; DEPRESSION; DERMATOME; DRUG ADMINISTRATION ROUTE; DRUG COST; DRUG DELIVERY SYSTEM; DRUG DOSE ESCALATION; DRUG EFFICACY; DRUG SUBSTITUTION; DRUG WITHDRAWAL; EPIDURAL ANESTHESIA; FATIGUE; GANGLION BLOCK; GASTROINTESTINAL SYMPTOM; HUMAN; HYPOGASTRIC PLEXUS; MENTAL DISEASE; MONOTHERAPY; NAUSEA; NEUROLYSIS; NEUROPATHIC PAIN; RESPIRATION DEPRESSION; SYMPATHETIC BLOCKING; UNSPECIFIED SIDE EFFECT; VISCERAL PAIN; WORLD HEALTH ORGANIZATION;

EID: 54749122852     PISSN: 00778923     EISSN: 17496632     Source Type: Book Series    
DOI: 10.1196/annals.1414.034     Document Type: Conference Paper

References (136)

1. Brescia, F.J. et al. 1992. Pain, opioid use, and survival in hospitalized patients with advanced cancer. J. Clin. Oncol. 10 : 149 155.
2. Cleeland, C.S. et al. 1994. Pain and its treatment in outpatients with metastatic cancer. N. Engl. J. Med. 330 : 592 596.
3. Portenoy, R.K. et al. 1992. Pain in ambulatory patients with lung or colon cancer. Prevalence, characteristics, and effect. Cancer 70 : 1616 1624.
4. Tolle, S.W. et al. 2000. Family reports of barriers to optimal care of the dying. Nurs. Res. 49 : 310 317.
5. Berry, P.H. & J.L. Dahl. 2000. The new JCAHO pain standards: implications for pain management nurses. Pain. Manag. Nurs. 1 : 3 12.
6. WHO. 1998. Cancer Pain Release. Available from : http://www. whocancerpain.wisc.edu/ (accessed Nov. 9, 2007).
7. Zech, D.F. et al. 1995. Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study. Pain 63 : 65 76.
8. Committee, W.E. 1990. Cancer pain relief and palliative care. In World Health Organ. Tech. Rep. Ser., W.H. Organization, Editor. 1 75.
9. Levy, R.M. 1996. Pharmacologic treatment of cancer pain. N. Engl. J. Med. 335 : 1124 1132.
10. Cherny, N.I. & K.M. Foley. 1997. Nonopioid and opioid analgesic pharmacotherapy of cancer pain. Otolaryngol. Clin. North Am. 30 : 279 306.
11. Pappagallo, M. 2001. Incidence, prevalence, and management of opioid bowel dysfunction. Am. J. Surg. 182 (5A Suppl 11S 18S.
12. Walsh, T.D. 1990. Prevention of opioid side effects. J. Pain Symptom. Manage. 5 : 362 367.
13. Bruera, E. et al. 1992. The use of methylphenidate in patients with incident cancer pain receiving regular opiates. A preliminary report. Pain 50 : 75 77.
14. Meuser, T. et al. 2001. Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology. Pain 93 : 247 157.
15. Miaskowski, C. et al. 2001. Lack of adherence with the analgesic regimen: a significant barrier to effective cancer pain management. J. Clin. Oncol. 19 : 4275 4279.
16. Bruera, E. et al. 1996. Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine. Cancer 78 : 852 857.
17. de Stoutz, N.D., E. Bruera & M. Suarez-Almazor. 1995. Opioid rotation for toxicity reduction in terminal cancer patients. J. Pain Symptom. Manage. 10 : 378 384.
18. Miguel, R. 2000. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder? Cancer Control. 7 : 149 156.
19. Agency for Health Care Policy and Research Rockville, Maryland. 1994. Management of cancer pain guideline overview. J. Natl. Med. Assoc. 86 : 571 573, 634.
20. Hogan, Q. et al. 1991. Epidural opiates and local anesthetics for the management of cancer pain. Pain 46 : 271 279.
21. Smitt, P.S. et al. 1998. Outcome and complications of epidural analgesia in patients with chronic cancer pain. Cancer 83 : 2015 2022.
22. Bedder, M.D., K. Burchiel & A. Larson. 1991. Cost analysis of two implantable narcotic delivery systems. J. Pain Symptom. Manage. 6 : 368 373.
23. Crul, B.J. & E.M. Delhaas. 1991. Technical complications during long-term subarachnoid or epidural administration of morphine in terminally ill cancer patients: a review of 140 cases. Reg. Anesth. 16 : 209 213.
24. Bahar, M., M. Rosen & M.D. Vickers. 1984. Chronic cannulation of the intradural or extradural space in the rat. Br. J. Anaesth. 56 : 405 410.
25. Baker, L. et al. 2004. Evolving spinal analgesia practice in palliative care. Palliat. Med. 18 : 507 515.
26. Sjoberg, M. et al. 1991. Long-term intrathecal morphine and bupivacaine in "refractory" cancer pain. I. Results from the first series of 52 patients. Acta Anaesthesiol. Scand. 35 : 30 43.
27. Nitescu, P. et al. 1992. Bacteriology, drug stability and exchange of percutaneous delivery systems and antibacterial filters in long-term intrathecal infusion of opioid drugs and bupivacaine in "refractory" pain. Clin. J. Pain. 8 : 324 337.
28. Nitescu, P. et al. 1998. Continuous infusion of opioid and bupivacaine by externalized intrathecal catheters in long-term treatment of "refractory" nonmalignant pain. Clin. J. Pain. 14 : 17 28.
29. Nitescu, P. et al. 1991. Long-term, open catheterization of the spinal subarachnoid space for continuous infusion of narcotic and bupivacaine in patients with "refractory" cancer pain. A technique of catheterization and its problems and complications. Clin. J. Pain. 7 : 143 161.
30. Nitescu, P. et al. 1990. Epidural versus intrathecal morphine- bupivacaine: assessment of consecutive treatments in advanced cancer pain. J. Pain Symptom. Manage. 5 : 18 26.
31. Penn, R.D. et al. 1984. Cancer pain relief using chronic morphine infusion. Early experience with a programmable implanted drug pump. J. Neurosurg. 61 : 302 306.
32. Sjoberg, M. et al. 1992. Neuropathologic findings after long-term intrathecal infusion of morphine and bupivacaine for pain treatment in cancer patients. Anesthesiology 76 : 173 186.
33. Dahm, P. et al. 1998. Efficacy and technical complications of long-term continuous intraspinal infusions of opioid and/or bupivacaine in refractory nonmalignant pain: a comparison between the epidural and the intrathecal approach with externalized or implanted catheters and infusion pumps. Clin. J. Pain. 14 : 4 16.
34. Gestin, Y., A. Vainio & A.M. Pegurier. 1997. Long-term intrathecal infusion of morphine in the home care of patients with advanced cancer. Acta Anaesthesiol. Scand. 41 (1 Pt 1 12 17.
35. Krames, E.S. & R.M. Lanning. 1993. Intrathecal infusional analgesia for nonmalignant pain: analgesic efficacy of intrathecal opioid with or without bupivacaine. J. Pain Symptom. Manage. 8 : 539 548.
36. Hassenbusch, S. et al. 2002. Management of intrathecal catheter-tip inflammatory masses: a consensus statement. Pain Med. 3 : 313 323.
37. Cabbell, K.L., J.A. Taren & O. Sagher. 1998. Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. Neurosurgery 42 : 1176 1180 discussion 1180-1181.
38. Langsam, A. 1999. Spinal cord compression by catheter granulomas in high-dose intrathecal morphine therapy: case report. Neurosurgery 44 : 689 691.
39. McMillan, M.R., T. Doud & W. Nugent. 2003. Catheter-associated masses in patients receiving intrathecal analgesic therapy. Anesth. Analg. 96 : 186 190, table of contents.
40. Corning, J. 1885. Spinal anaesthesia and local medication of the cord. N. Y. Med. J. 42 : 483 485.
41. Brill, S., G.M. Gurman & A. Fisher. 2003. A history of neuraxial administration of local analgesics and opioids. Eur. J. Anaesthesiol. 20 : 682 689.
42. Wallace, M. & T.L. Yaksh. 2000. Long-term spinal analgesic delivery: a review of the preclinical and clinical literature. Reg. Anesth. Pain Med. 25 : 117 157.
43. Prager, J.P. 2002. Neuraxial medication delivery: the development and maturity of a concept for treating chronic pain of spinal origin. Spine 27 : 2593 2605 discussion 2606.
44. Vainio, A. & A. Auvinen. 1996. Prevalence of symptoms among patients with advanced cancer: an international collaborative study. symptom prevalence group. J. Pain Symptom. Manage. 12 : 3 10.
45. Smith, T.J. et al. 2002. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J. Clin. Oncol. 20 : 4040 4049.
46. Krames, E.S. 1996. Intraspinal opioid therapy for chronic nonmalignant pain: current practice and clinical guidelines. J. Pain Symptom. Manage. 11 : 333 352.
47. Hassenbusch, S.J. et al. 2004. Polyanalgesic Consensus Conference 2003: an update on the management of pain by intraspinal drug delivery - report of an expert panel. J. Pain Symptom. Manage. 27 : 540 563.
48. Eisenach, J.C. et al. 1995. Epidural clonidine analgesia for intractable cancer pain. The epidural clonidine study group. Pain 61 : 391 399.
49. Coombs, D., L.H. Maurer, R.I. Saunders & M. Gaylor. 1984. Outcomes and complications of continuous intraspinal narcotic analgesia for cancer pain control. J. Clin. Oncol. 2 : 1414 1420.
50. Ackerman, L.L., K.A. Follett & R.W. Rosenquist. 2003. Long-term outcomes during treatment of chronic pain with intrathecal clonidine or clonidine/opioid combinations. J. Pain Symptom. Manage. 26 : 668 677.
51. Stearns, L. et al. 2005. Intrathecal drug delivery for the management of cancer pain: a multidisciplinary consensus of best clinical practices. J. Support. Oncol. 3 : 399 408.
52. Sjoberg, M. et al. 1994. Long-term intrathecal morphine and bupivacaine in patients with refractory cancer pain. Results from a morphine:bupivacaine dose regimen of 0.5:4.75 mg/ml. Anesthesiology 80 : 284 297.
53. Staats, P.S. et al. 2004. Intrathecal ziconotide in the treatment of refractory pain in patients with cancer or AIDS: a randomized controlled trial. JAMA 291 : 63 70.
54. Deer, T.K., E.S. Hassenbusch, et al. 2007. Polyanalgesic consensus conference 2007: recommendations for the management of pain by intrathecal (intraspinal) drug delivery: report of an interdisciplinary expert panel. Neuromodulation 10 : 301 328.
55. Elan Pharmaceuticals, I. 2005. Prialt (Ziconotide) Prescribing Information. Dublin.
56. Ridgeway, B., M. Wallace & A. Gerayli. 2000. Ziconotide for the treatment of severe spasticity after spinal cord injury. Pain 85 : 287 289.
57. Turner, J.A., J.M. Sears & J.D. Loeser. 2007. Programmable intrathecal opioid delivery systems for chronic noncancer pain: a systematic review of effectiveness and complications. Clin. J. Pain. 23 : 180 195.
58. de Lissovoy, G. et al. 1997. Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome. Clin. Ther. 19 : 96 112 discussion 84-85.
59. Prager, J. & M. Jacobs. 2001. Evaluation of patients for implantable pain modalities: medical and behavioral assessment. Clin. J. Pain 17 : 206 214.
60. Hassenbusch, S.J. et al. 1995. Long-term intraspinal infusions of opioids in the treatment of neuropathic pain. J. Pain. Symptom. Manage. 10 : 527 543.
61. Devulder, J. et al. 1994. Spinal analgesia in terminal care: risk versus benefit. J. Pain Symptom. Manage. 9 : 75 81.
62. Onofrio, B.M. & T.L. Yaksh. 1990. Long-term pain relief produced by intrathecal morphine infusion in 53 patients. J. Neurosurg. 72 : 200 209.
63. Penn, R.D. & J.A. Paice. 1987. Chronic intrathecal morphine for intractable pain. J. Neurosurg. 67 : 182 186.
64. Meenan, D. et al. 1999. Managing intractable pain with an intrathecal catheter and injection port: technique and guidelines. Am. Surg. 65 : 1054 1060.
65. Ricci, V., A. Dalpane & E. Lolli. 1995. Continuous spinal analgesia in home care of oncologic pain. Minerva. Med. 86 : 409 414.
66. Schultheiss, R., J. Schramm & J. Neidhardt. 1992. Dose changes in long- and medium-term intrathecal morphine therapy of cancer pain. Neurosurgery 31 : 664 669 discussion 669-670.
67. Serlin, R.C. et al. 1995. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61 : 277 284.
68. Chochinov, H.M. et al. 1999. Will to live in the terminally ill. Lancet 354 : 816 819.
69. Lillemoe, K.D. et al. 1993. Chemical splanchnicectomy in patients with unresectable pancreatic cancer. A prospective randomized trial. Ann. Surg. 217 : 447 455 discussion 456-457.
70. Candido, K. & R.A. Stevens. 2003. Intrathecal neurolytic blocks for the relief of cancer pain. Best. Pract. Res. Clin. Anaesthesiol. 17 : 407 428.
71. Patt, R.B. 1993. Cancer Pain. Lippincott. Philadelphia, xxi, 650 p.
72. Cousins, M., B. Dwyer & D. Bigg. 1988. Chronic pain and neurolytic blockade. In Neural Blockade in Clinical Anesthesia and Management of Pain, 2 edn. M. Cousins & P.O. Bridenbaugh, Eds. JB Lippincott. Philadelphia.
73. Waxman, S. 2003. Clinical Neuroanatomy. Lange Medical Books/McGraw-Hill. New York.
74. Winnie, A. 1996. Subarachnoid neurolytic blocks. In Interventional Pain Management. W.A. Waldman, Ed., 401. WB Saunders. Philadephia.
75. Gerbershagen, H.U. 1981. Neurolysis. Subarachnoid neurolytic blockade. Acta Anaesthesiol. Belg. 32 : 45 57.
76. Bonica, J.B., F.P., G. Moricca, et al. 1990. Neurolytic blockade and hypophysectomy. In The Management of Pain, 2nd edn. J. Bonica, Ed. Lea & Febiger. Philadelphia, 1980.
77. Kappis, M. 1919. Sensibilitat und lokale anasthesie im chirurgischen gebeit der bauchkikle mit besonderer berucksichtigung der splanchnicusanasthesia. Beitr. Klin. Chir. 115 : 161 175.
78. Ischia, S. et al. 1998 Labat Lecture: the role of the neurolytic celiac plexus block in pancreatic cancer pain management: do we have the answers? Reg. Anesth. Pain. Med. 23 : 611 614.
79. Eisenberg, E., D.B. Carr & T.C. Chalmers. 1995. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth. Analg. 80 : 290 295.
80. Ischia, S. et al. 2000. Celiac block for the treatment of pancreatic pain. Curr. Rev. Pain. 4 : 127 133.
81. Ward, E.M. et al. 1979. The celiac ganglia in man: normal anatomic variations. Anesth. Analg. 58 : 461 465.
82. Singler, R.C. 1982. An improved technique for alcohol neurolysis of the celiac plexus. Anesthesiology 56 : 137 141.
83. Woodburne, R. 1973. Essentials of Human Anatomy, 5th edn. 450 454. Oxford University Press. Oxford, England.
84. Boas, R. 1978. Sympathetic blocks in clinical practice. Int. Anesthesiol. Clin. 16 : 149 182.
85. Moore, D. 1984. Intercostal nerve block and celiac plexus block for pain therapy. In Advances in Pain Research and Therapy, Vol. 7. C. Beneditti, et al., Eds. 309 329. Raven Press. New York.
86. Mercadante, S. and F. Nicosia. 1998. Celiac plexus block: a reappraisal. Reg. Anesth. Pain Med. 23 : 37 48.
87. Moore, D.C., W.H. Bush & L.L. Burnett. 1981. Celiac plexus block: a roentgenographic, anatomic study of technique and spread of solution in patients and corpses. Anesth. Analg. 60 : 369 379.
88. Lieberman, R.P. & S.D. Waldman. 1990. Celiac plexus neurolysis with the modified transaortic approach. Radiology 175 : 274 276.
89. Brown, D.L. & D.C. Moore. 1988. The use of neurolytic celiac plexus block for pancreatic cancer: anatomy and technique. J. Pain Symptom. Manage. 3 : 206 209.
90. Rathmell, J.P. 2006. Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine, 1st edn. 128 129. Lippincott Williams & Wilkins. Philadelphia.
91. Ischia, S. et al. 1983. A new approach to the neurolytic block of the coeliac plexus: the transaortic technique. Pain 16 : 333 341.
92. Romanelli, D.F., C.F. Beckmann & F.W. Heiss. 1993. Celiac plexus block: efficacy and safety of the anterior approach. Am. J. Roentgenol. 160 : 497 500.
93. Davies, D.D. 1993. Incidence of major complications of neurolytic coeliac plexus block. J. R. Soc. Med. 86 : 264 266.
94. Lieberman, R., S.L. Lieberman, D.J. Cuka & G.B. Lund. 1988. Celiac plexus and splanchnic nerve block: a review. Semin. Intervent. Radiol. 5 : 257 266.
95. Wong, G. & Brown, D.L. 1995. Transient paraplegia following alcohol celiac plexus block. Reg. Anesth. 20 : 352 355.
96. Woodham, M.J. & M.H. Hanna. 1989. Paraplegia after coeliac plexus block. Anaesthesia 44 : 487 489.
97. Prasanna, A. 1996. Unilateral celiac plexus block. J. Pain Symptom Manage 11 : 154 157.
98. Ischia, S.P. 1999. Computed tomography eliminates paraplegia and/or death from neurolytic celiac plexus block. Reg. Anesthesia Pain Med. 24 : 484 486.
99. Moore, D.C. 1999. Computed tomography eliminates paraplegia and/or death from neurolytic celiac plexus block. Reg. Anesthesia Pain Med. 24 : 483.
100. Mercadante, S. 1993. Celiac plexus block versus analgesics in pancreatic cancer pain. Pain 52 : 187 192.
101. Polati, E. et al. 1998. Prospective randomized double-blind trial of neurolytic coeliac plexus block in patients with pancreatic cancer. Br. J. Surg. 5 : 199 201.
102. Weber, J.G. et al. 1996. Celiac plexus block. Retrocrural computed tomographic anatomy in patients with and without pancreatic cancer. Reg. Anesth. 21 : 407 413.
103. Iki, K. et al. 2003. Celiac plexus block: evaluation of injectate spread by three-dimensional computed tomography. Abdom. Imaging. 28 : 571 573.
104. Rosenberg, S.K. et al. 1998. Superior hypogastric plexus block successfully treats severe penile pain after transurethral resection of the prostate. Reg. Anesth. Pain. Med. 23 : 618 620.
105. de Leon-Casasola, O.A. 2000. Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain. Cancer Control. 7 : 142 148.
106. Mauroy, B. et al. 2003. The inferior hypogastric plexus (pelvic plexus): its importance in neural preservation techniques. Surg. Radiol. Anat. 25 : 6 15.
107. Plancarte, R. et al. 1990. Superior hypogastric plexus block for pelvic cancer pain. Anesthesiology 73 : 236 239.
108. de Leon-Casasola, O.A., E. Kent & M.J. Lema. 1993. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Pain 54 : 145 151.
109. Wechsler, R.J. et al. 1995. Superior hypogastric plexus block for chronic pelvic pain in the presence of endometriosis: CT techniques and results. Radiology 196 : 103 106.
110. Cariati, M. et al. 2002. CT-guided superior hypogastric plexus block. J. Comput. Assist. Tomogr. 26 : 428 431.
111. Michalek, P. & J. Dutka. 2005. Computed tomography-guided anterior approach to the superior hypogastric plexus for noncancer pelvic pain: a report of two cases. Clin. J. Pain. 21 : 553 556.
112. de Oliveira, R., M.P. dos Reis & W.A. Prado. 2004. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain 110 : 400 408.
113. Kitoh, T. et al. 2005. Combined neurolytic block of celiac, inferior mesenteric, and superior hypogastric plexuses for incapacitating abdominal and/or pelvic cancer pain. J. Anesth. 19 : 328 332.
114. Waldman, S.D., W.L. Wilson & R.D. Kreps. 1991. Superior hypogastric plexus block using a single needle and computed tomography guidance: description of a modified technique. Reg. Anesth. 16 : 286 287.
115. Erdine, S. et al. 2003. Transdiscal approach for hypogastric plexus block. Reg. Anesth. Pain Med. 28 : 304 308.
116. Kanazi, G.E. et al. 1999. New technique for superior hypogastric plexus block. Reg. Anesth. Pain Med. 24 : 473 476.
117. Soysal, M.E. et al. 2003. Laparoscopic presacral neurolysis for endometriosis-related pelvic pain. Hum. Reprod. 18 : 588 592.
118. Chen, F.P., T.S. Lo & Y.K. Soong. 1998. Management of chylous ascites following laparoscopic presacral neurectomy. Hum. Reprod. 13 : 880 883.
119. Kwok, A., A. Lam & R. Ford. 2001. Laparoscopic presacral neurectomy: a review. Obstet. Gynecol. Surv. 56 : 99 104.
120. Plancarte, R. et al. 1997. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg. Anesth. 22 : 562 568.
121. Chan, W.S. et al. 1997. Computed tomography scan-guided neurolytic superior hypogastric block complicated by somatic nerve damage in a severely kyphoscoliotic patient. Anesthesiology 86 : 1429 1430.
122. Dutka, J.M. 2002. Neurological complications in neurolytic blocks in the visceral and pelvic regions. Int. Monitor. Reg. Anesth. 14 : 69.
123. Plancarte, R.A., R.B. Patt, et al. 1990. Presacral blockade of the ganglion of Walther (ganglion impar). Anesthesiology 73 : A751.
124. Foye, P.M. 2007. New approaches to ganglion impar blocks via coccygeal joints. Reg. Anesthesia Pain Med. 32 : 269.
125. Hong, J.H. & H.S. Jang. 2006. Block of the ganglion impar using a coccygeal joint approach. Reg. Anesthesia Pain Med. 31 : 583.
126. Munir, M.A., J. Zhang & M. Ahmad. 2004. A modified needle-inside-needle technique for the ganglion impar block: [Une technique modifiee pour le bloc du ganglion coccygien : une aiguille dans une aiguille]. Can. J. Anesth. 51 : 915 917.
127. Nebab, E.G. & I.M. Florence. 1997. An alternative needle geometry for interruption of the ganglion impar. Anesthesiology 86 : 1213 1214.
128. Loev, M.A. et al. 1998. Cryoablation: a novel approach to neurolysis of the ganglion impar. Anesthesiology 88 : 1391 1393.
129. Yeo, S.N. & J.L. Chong. 2001. A case report on the treatment of intractable anal pain from metastatic carcinoma of the cervix. Ann. Acad. Med. Singapore 30 : 632 635.
130. Oh, C.S. et al. 2004. Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology 101 : 249 250.
131. Reig, E. et al. 2005. Thermocoagulation of the ganglion impar or ganglion of walther: description of a modified approach. Preliminary results in chronic, nononcological pain. Pain Practice 5 : 103 110.
132. de Leon-Casasola, O. 1997. Superior hypogastric plexus block and ganglion impar neurolysis for pain associated with cancer. Tech. Reg. Anesth Pain Manag. 1 : 27 31.
133. Wemm, K., Jr. & L. Saberski. 1995. Modified approach to block the ganglion impar (ganglion of Walther). Reg. Anesth. 20 : 544 545.
134. Huang, J.J. 2003. Another modified approach to the ganglion of Walther block (ganglion of impar). J. Clin. Anesth. 15 : 282 283.
135. de Leon-Casaola, O.A. 2001. Ganglion impar block: critical evaluation. Tech. Reg. Anesth. Pain Manag. 5 : 120 122.
136. Swofford, J.R. & D.M. Ratzman. 1998. A transarticular approach to blockade of the ganglion impar (ganglion of walther). Reg. Anesth. Pain. Med. 23 : 103.