Efficacy of Neurolytic Celiac Plexus Block in Varying Locations of Pancreatic Cancer

Background Neurolytic celiac plexus block (NCPB) is an effective way of treating severe pain in some patients with pancreatic malignancy. However, there are no studies to date that evaluate the effectiveness of NCPB related to the site of primary pancreas cancer. The aim of the study was to assess the effectiveness of NCPB in pancreatic cancer pain, depending on the location of the pancreatic tumor. Methods The prospective study was conducted in 50 consecutive patients diagnosed with pancreatic cancer. The patients were categorized into two different groups depending on tumor localization: group 1: patients with the cancer of the head of the pancreas and group 2: patients with the cancer of the body and tail of the pancreas. The qualitative and quantitative pain analyses were performed before and after NCPB. The patients underwent prognostic celiac plexus block with bupivacaine, followed by neurolysis during fluoroscopic control within the next 24 h. Results After NCPB, 37 patients (74%) had effective pain relief during the first 3 months or until death. Of the 37 patients who had effective pain relief, 33 (92%) were from group 1 and 4 (29%) were from group 2. In the remaining 13 patients (3 patients from group 1 and 10 patients from group 2), pain relief after NCPB was not satisfactory. Those patients were scheduled for repeated retrocrural neurolysis during computed tomography control. Computed tomography showed massive growth of the tumor around the celiac axis with metastases. After repeated neurolysis, pain relief clinically still was not satisfactory, necessitating additional opioid treatment. Conclusion In this study, unilateral transcrural celiac plexus neurolysis has been shown to provide effective pain relief in 74% of patients with pancreatic cancer pain. Neurolysis was more effective in cases with tumor involving the head of the pancreas. In the cases with advanced tumor proliferation, regardless of the technique used, the analgesic effects of NCPB were not satisfactory.

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Neurolytic Celiac Plexus Block for Visceral Abdominal Malignancy: Is Prior Diagnostic Block Warranted?

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000407 ◽

2002 ◽

Vol 30 (4) ◽

pp. 442-448 ◽

Cited By ~ 19

Author(s):

T. S. T. Yuen ◽

K. F. J. Ng ◽

S. L. Tsui

Keyword(s):

Predictive Value ◽

Positive Response ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Block Group ◽

Diagnostic Block ◽

Neurolytic Block ◽

Group 2 ◽

Plexus Block ◽

Group 1

Neurolytic celiac plexus block is a recognised treatment for visceral abdominal pain due to malignancy. The need for a diagnostic celiac plexus block prior to neurolytic blockade is of questionable value, as it may not predict a positive response and may incorrectly predict a lack of response. Our objective is to evaluate the efficacy of diagnostic celiac plexus block. The records of 59 patients treated with celiac plexus block during 1994–2000 were retrospectively reviewed. Diagnostic block was performed on 32 patients prior to the decision for subsequent neurolytic block (Group 1). Another 27 patients were directly treated with a neurolytic celiac plexus block (Group 2). Response of Group 1 to diagnostic and neurolytic blocks was compared. Data from Group 2 was used to project the response of Group 1 should those patients with negative response to diagnostic block proceeded to neurolytic block. A two-by-two table was then constructed. The diagnostic celiac plexus block predicted a positive response with a sensitivity of 93% and a specificity of 37%. The positive predictive value was 85% and the negative predictive value was 58%. The estimated “number needed to test” before a “true” nonrespondent to lytic block to be detected was 16.7. Therefore, a positive response to diagnostic block correlates positively with neurolytic celiac plexus block for abdominal visceral pain due to malignancy. However, diagnostic block is a poor predictor when the response is negative. Hence, its clinical role is questionable and may not be warranted for patients with terminal malignancy.

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Improving Palliation in Pancreatic Cancer: Intraoperative Celiac Plexus Block for Pain Relief

Southern Medical Journal ◽

10.1097/00007611-199104000-00014 ◽

1991 ◽

Vol 84 (4) ◽

pp. 469-471 ◽

Cited By ~ 23

Author(s):

KENNETH W. SHARP ◽

EMILY J. STEVENS

Keyword(s):

Pancreatic Cancer ◽

Pain Relief ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Plexus Block

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Intraoperative neurolytic celiac plexus block with Frey's procedure for effective pain relief in patients with chronic calcific pancreatitis – Prospective randomized double-blind placebo controlled trial

HPB ◽

10.1016/j.hpb.2016.02.060 ◽

2016 ◽

Vol 18 ◽

pp. e22-e23

Author(s):

R. Vellaisamy ◽

B. Sathyamoorthy ◽

S. Sankareswaran ◽

A. Anbalagan ◽

B. Duraisamy ◽

...

Keyword(s):

Pain Relief ◽

Controlled Trial ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Double Blind ◽

Double Blind Placebo ◽

Chronic Calcific Pancreatitis ◽

Effective Pain Relief ◽

Plexus Block ◽

Calcific Pancreatitis

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Celiac plexus block in patients with nonpancreatic GI malignancies: Experience from a single institution.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19551 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19551-e19551

Author(s):

Shejal B Patel ◽

James Edward Shaw

Keyword(s):

Pancreatic Cancer ◽

Pain Relief ◽

Celiac Plexus ◽

Cochrane Library ◽

Celiac Plexus Block ◽

Sufficient Data ◽

Pain Scores ◽

Post Procedure ◽

Physician Assessment ◽

Plexus Block

e19551 Background: Celiac plexus block (CPB) has been well described in the treatment of pancreatic cancer pain. A recent Cochrane Library review of the subject concluded that CPB often resulted in fewer adverse effects when compared to chronic opioid use. CPB has not been well described in non-pancreatic GI malignancies. This study sought to determine the effectiveness of CPB in non-pancreatic GI malignancies. Methods: The Virginia Commonwealth University Massey Cancer Center database was queried for all patients who had undergone celiac plexus block, 2001-2010, using specific CPT billing codes. In addition, VCU Radiology Department records were also examined. Diagnosis, physician assessment of effectiveness, pre and post procedure pain scores, complications of procedure, and pain medication dosage pre and post procedure were all assessed. Results: 68 total patients were identified. 12 patients underwent a CPB for non-pancreatic GI malignancies and 56 for pancreatic cancer patients. The most common non-pancreatic GI malignancies were colorectal cancer (50%), hepatocellular carcinoma (8%), carcinoid (8%), duodenal cancer (8%), and gastric cancer (8%). By study criteria, 7 of the 12 patients had sufficient data for exploratory analysis. By physician assessment, CPB resulted in pain relief in 5 (71%) of 7 patients. Furthermore, the post procedure pain score improved but the usage of pain medications did not change. By comparison, 26 of 56 patients with pancreatic CA had sufficient data and 15(58%) has pain relief by physician assessment. Conclusions: CPB appears to provide some pain relief for patients with non-pancreatic GI malignancies. However, the retrospective design revealed missing data including: pre and post procedure pain scores, complications of procedure and patient assessments of pain. A prospective study is being considered.

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