Background
Methods
Results
Conclusion
Keywords
Chronic pelvic cancer pain is a major and distressing symptom. In addition to conventional
treatments such as analgesics and surgical interventions, the superior hypogastric plexus block
(SHPB) serves as an alternative option for managing severe pain. This study aimed to compare
the outcomes of two imaging modalities—ultrasound and fluoroscopy—for guiding SHPB.
A systematic search was conducted in PubMed, Cochrane Library, Web of Science, Scopus,
and Elsevier ScienceDirect for randomized controlled trials (RCTs) published before May
2025. The effectiveness of ultrasound-guided and fluoroscopy-guided SHPB was compared
in terms of pain intensity (primary outcome), morphine consumption, quality of life (QOL),
patient satisfaction, procedure duration, and post-procedural complications. Subgroup
analyses were performed based on different time-points.
The analysis included four RCTs involving 246 patients. No significant differences in pain
relief were observed in one week, one month, two months, or three months between the
ultrasound-guided and fluoroscopy-guided groups. However, the overall effect showed
significantly lower pain scores in the ultrasound-guided group (SMD= -0.39, 95% CI [-0.70, -0.07], p= 0.02), with substantial heterogeneity (I²= 79%). No significant differences were
found for morphine consumption, QOL, patient satisfaction, or procedure duration. Notably,
t
h e ul t r a s o u n d- g u i d e d g r o u p h a d s i g n i fi c a n t l y f e w e r p r o c e d u r e- r e l a t e d c o m p l i c a t i o n s
(RR= 0.35, 95% CI [0.15, 0.81], p= 0.01), with moderate heterogeneity (I²= 46%).
Ultrasound-guided SHPB was comparable to the conventional fluoroscopy-guided approach
for long-term pain control and was associated with a lower risk of adverse effects.