Continuous inferior mesenteric ganglion block for the control of abdominal pain.

Abstract

A 71-year-old woman was referred for control of intractable left-sided abdominal pain and constipation caused by stage 2B rectosigmoid colon cancer. She was treated with an intravenous morphine sulfate infusion at 4 mg/h which made her drowsy and lethargic. Because the distal colon is innervated by the inferior mesenteric sympathetic ganglion, it was hypothesized that a continuous block of this ganglion would provide both pain control and increased intestinal motility. The patient was placed in a prone position, and a Tuohy needle was placed at an entry site 7 cm lateral to the L3 spinous process. The needle was advanced 2 cm anterior to the L3 vertebral body with fluoroscopic guidance. An 18-gauge indwelling catheter was placed through the needle and a continuous infusion with 0.1% bupivacaine was maintained for 4 days. The patient obtained immediate pain relief and bowel motility. She remained awake and comfortable throughout the duration of therapy. She was discharged home 3 days after stopping the infusion and required a minimal amount of opioids. Continuous inferior mesenteric ganglion block may be an option in providing relief for pain caused by distal colon pathology.