Background: Abdominal pain from primary cancer or metastatic disease is a significant cause
of pain for patients undergoing treatment for the disease. Patient’s pain may be resistant to
conventional analgesics. The need for timely pain relief in order to facilitate further care in the
cancer treatment plan should be a priority.
Objectives: The aim of this retrospective observational review was to assess the relief given with
a low volume neurolytic retrocrural celiac plexus nerve block, the duration of the procedure, the
duration of relief, the reduction in daily opioid consumption, and the improvement of quality of life
in a patient suffering from incapacitating abdominal pain due to primary abdominal malignancy or
abdominal metastatic disease. Patients were given a neurolytic celiac plexus block without previous
diagnostic block due to multiple comorbidities.
Study Design: This is a retrospective, observational study.
Methods: Five hundred and seven patients were studied and data at 5 months for 455 patients
were retained at the end of the review. They were evaluated in the pain center prior to and after the
neurolytic retrocrural celiac plexus nerve block under fluoroscopic guidance. They were assessed on
duration of procedure, pain scores (numeric rating scale 0-10), daily opioid consumption, quality of
life improvement (simple yes or no question at 3 months) and routine follow-up during treatment
for the cancer for 6 months or end of life. All data was gathered by extensive chart review and
placed on a spreadsheet for analysis.
Results: Follow-up was completed 6 months after the procedure. Pain scores, daily opioid
consumption, and quality of life showed improvement for the duration of the study. There
was some return in pain during the fourth to sixth month due to disease progression and the
anticipated duration of the neurolytic agent. Some short duration known side effects did occur.
An initial vascular contrast uptake of 6.7% was noted during the procedure while utilizing digital
subtraction angiography with fluoroscopy.
Limitations: A larger sample size would be ideal, as well as, a prospective trial with a control
group, but this is unrealistic in our patient population. A proven quality of life questionnaire
would be beneficial. Comparing alcohol, phenol and radiofrequency thermocoagulation would be
interesting to equate duration, effect, and side effects.
Conclusion: Low volume neurolytic retrocrural celiac plexus nerve block with phenol is a safe
procedure providing up to 6 months of pain relief and is an effective, well-established, minimally
time-consuming procedure for abdominal pain due to primary malignancy or metastatic spread.
Key words: Celiac plexus, neurolytic, abdominal cancer pain, pain, retrocrural, cancer pain
Abstract No. 121 Single-center review of celiac plexus/retrocrural splanchnic nerve block for non–cancer-related pain