{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:48Z","timestamp":1756339548570,"version":"3.44.0"},"reference-count":26,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,18]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Patients with inoperable hepatobiliary cancers often endure severe abdominal pain, which impacts their quality of life. This pain is usually a combination of both nociceptive and neuropathic pain, which necessitates a comprehensive multimodal approach for effective management. Splanchnic nerve plexus block (SNB) has shown promising results in this regard. This case series reviews the literature and clinical practices, exploring the potential benefits of early SNB in the palliative care of patients with hepatobiliary cancers. We describe three cases illustrating SNB\u2019s potential in achieving notable pain relief. Each patient reported a pain reduction from 10\/10 to less than 1\/10, a reduced requirement for opioids and sustained relief at a 1-month follow-up. This case series suggests the potential role of SNB in select patients with ongoing oncology therapy for alleviating severe pain, decreasing opioid requirements and potentially enhancing overall functional status.<\/jats:p>","DOI":"10.1136\/bcr-2024-264093","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T21:30:17Z","timestamp":1751405417000},"page":"e264093","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Optimising palliative care: the role of early splanchnic nerve block in advanced hepatobiliary cancer"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4015-5461","authenticated-orcid":false,"given":"Himanshu","family":"Varshney","sequence":"first","affiliation":[{"name":"Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5047-7911","authenticated-orcid":false,"given":"Prateek","family":"Maurya","sequence":"additional","affiliation":[{"name":"Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachidanand Jee","family":"Bharati","sequence":"additional","affiliation":[{"name":"Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8444-2564","authenticated-orcid":false,"given":"Nishkarsh","family":"Gupta","sequence":"additional","affiliation":[{"name":"Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences New Delhi, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"2025082710230323000_18.7.e264093.1","first-page":"330","article-title":"Pain relief in upper abdominal malignancy","volume":"5","author":"Johnson","year":"2006","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"2025082710230323000_18.7.e264093.2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19960801)78:3<639::AID-CNCR45>3.0.CO;2-X"},{"key":"2025082710230323000_18.7.e264093.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2005.03.012"},{"key":"2025082710230323000_18.7.e264093.4","first-page":"640","article-title":"Transhiatal bilateral splanchnicotomy for pain control in pancreatic cancer: basic anatomy, surgical technique, and immediate results in fifty-one cases","volume":"111","author":"Sastre","year":"1992","journal-title":"Surgery"},{"key":"2025082710230323000_18.7.e264093.5","doi-asserted-by":"crossref","unstructured":"Haroun HS . Clinical anatomy of the splanchnic nerves. MOJAP 2018;5. doi:10.15406\/mojap.2018.05.00169","DOI":"10.15406\/mojap.2018.05.00169"},{"key":"2025082710230323000_18.7.e264093.6","doi-asserted-by":"publisher","DOI":"10.1002\/ca.20599"},{"key":"2025082710230323000_18.7.e264093.7","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001939"},{"key":"2025082710230323000_18.7.e264093.8","doi-asserted-by":"crossref","unstructured":"Shaikh S . The practice of cancer pain: a case series. In: Gulati A , Puttanniah V , Bruel B , et al ., eds. Essentials of Interventional Cancer Pain Management. Cham, Switzerland: Springer, 2019: 5\u20139.","DOI":"10.1007\/978-3-319-99684-4_2"},{"key":"2025082710230323000_18.7.e264093.9","doi-asserted-by":"crossref","DOI":"10.1155\/2014\/941726","article-title":"Splanchnicectomy for pancreatic cancer pain","volume":"2014","author":"Masuda","year":"2014","journal-title":"Biomed Res Int"},{"key":"2025082710230323000_18.7.e264093.10","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29210"},{"key":"2025082710230323000_18.7.e264093.11","first-page":"101813","article-title":"Trends in incidence of primary liver cancer: a registry-based analysis from India","volume":"69","author":"Dixit","year":"2020","journal-title":"Cancer Epidemiol"},{"key":"2025082710230323000_18.7.e264093.12","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0022"},{"key":"2025082710230323000_18.7.e264093.13","first-page":"238","article-title":"Diagnostic accuracy and adequacy of fine needle aspiration cytology of liver lesions","volume":"35","author":"Kapoor","year":"2018","journal-title":"J Cytol"},{"key":"2025082710230323000_18.7.e264093.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.06.007"},{"key":"2025082710230323000_18.7.e264093.15","first-page":"ii41","article-title":"Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010","volume":"65 Suppl 2","author":"Davies","year":"2010","journal-title":"Thorax"},{"key":"2025082710230323000_18.7.e264093.16","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70040-2"},{"key":"2025082710230323000_18.7.e264093.17","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/ALN.0000000000003936","article-title":"Neurolytic Splanchnic Nerve Block and Pain Relief, Survival, and Quality of Life in Unresectable Pancreatic Cancer: A Randomized Controlled Trial","volume":"135","author":"Dong","year":"2021","journal-title":"Anesthesiology"},{"key":"2025082710230323000_18.7.e264093.18","first-page":"488","article-title":"Management of cancer pain: ASCO clinical practice guideline summary","volume":"14","author":"Loprinzi","year":"2018","journal-title":"J Oncol Pract"},{"key":"2025082710230323000_18.7.e264093.19","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy152"},{"key":"2025082710230323000_18.7.e264093.20","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.4103\/ija.ija_439_23","article-title":"Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis","volume":"67","author":"Goyal","year":"2023","journal-title":"Indian J Anaesth"},{"key":"2025082710230323000_18.7.e264093.21","doi-asserted-by":"crossref","first-page":"371","DOI":"10.4103\/sja.sja_86_24","article-title":"A case series of fluoroscopy-guided neurolytic splanchnic nerve block for chronic pancreatitis pain","volume":"18","author":"Jyothi","year":"2024","journal-title":"Saudi J Anaesth"},{"key":"2025082710230323000_18.7.e264093.22","first-page":"422","article-title":"Splanchnic nerve radiofrequency ablation for abdominal cancer pain","volume":"56","author":"Mercadante","year":"2018","journal-title":"J Pain Symptom Manage"},{"key":"2025082710230323000_18.7.e264093.23","unstructured":"Wallace MS . Interventions for treating pain and disability in adults with complex regional pain syndrome. Cochrane Database Syst Rev 2017."},{"key":"2025082710230323000_18.7.e264093.24","unstructured":"Subramaniam S , Rajendran A , Gobinath M , et al . Effects of the Celiac Plexus Block versus Splanchnic Nerve Block for Upper Abdominal Tumors on Pain Relief and Quality of Life\u2013randomized Comparative Study. International Journal of Scientific Study 2021;8."},{"key":"2025082710230323000_18.7.e264093.25","unstructured":"World Health Organization . WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization, 2018."},{"key":"2025082710230323000_18.7.e264093.26","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/j.1526-4637.2009.00785.x","article-title":"Spinal cord stimulation for chronic visceral abdominal pain","volume":"11","author":"Kapural","year":"2010","journal-title":"Pain Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264093","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:23:09Z","timestamp":1756315389000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":26,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,1]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bcr-2024-264093"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264093","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}