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

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

Anesthesiology ◽

10.1097/00000542-200002000-00014 ◽

2000 ◽

Vol 92 (2) ◽

pp. 347-347 ◽

Cited By ~ 84

Author(s):

Jan J. Rykowski ◽

Maciej Hilgier

Keyword(s):

Computed Tomography ◽

Pancreatic Cancer ◽

Pain Relief ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Head Of The Pancreas ◽

Group 2 ◽

Effective Pain Relief ◽

Plexus Block ◽

Group 1

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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Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation

Anesthesiology ◽

10.1097/aln.0b013e3181e33ae5 ◽

2010 ◽

Vol 113 (2) ◽

pp. 395-405 ◽

Cited By ~ 98

Author(s):

Steven P. Cohen ◽

Kayode A. Williams ◽

Connie Kurihara ◽

Conner Nguyen ◽

Cynthia Shields ◽

...

Keyword(s):

Positive Response ◽

The United States ◽

Successful Outcome ◽

Medial Branch ◽

Cost Effective Treatment ◽

Pain Clinics ◽

Radiofrequency Denervation ◽

Diagnostic Block ◽

Group 2 ◽

Group 1

Background Among patients presenting with axial low back pain, facet arthropathy accounts for approximately 10-15% of cases. Facet interventions are the second most frequently performed procedures in pain clinics across the United States. Currently, there are no uniformly accepted criteria regarding how best to select patients for radiofrequency denervation. Methods A randomized, multicenter study was performed in 151 subjects with suspected lumbar facetogenic pain comparing three treatment paradigms. Group 0 received radiofrequency denervation based solely on clinical findings; group 1 underwent denervation contingent on a positive response to a single diagnostic block; and group 2 proceeded to denervation only if they obtained a positive response to comparative blocks done with lidocaine and bupivacaine. A positive outcome was predesignated as > or =50% pain relief coupled with a positive global perceived effect persisting for 3 months. Results In group 0, 17 patients (33%) obtained a successful outcome at 3 months versus eight patients (16%) in group 1 and 11 (22%) patients in group 2. Denervation success rates in groups 0, 1, and 2 were 33, 39, and 64%, respectively. Pain scores and functional capacity were significantly lower at 3 months but not at 1 month in group 2 subjects who proceeded to denervation compared with patients in groups 0 and 1. The costs per successful treatment in groups 0, 1, and 2 were $6,286, $17,142, and $15,241, respectively. Conclusions Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.

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Celiac Plexus Neurolysis Using Three Different Techniques for Upper Abdominal Metastatic Pain: Comparison the Effectiveness of the Block

Bangladesh Medical Journal ◽

10.3329/bmj.v41i2.18800 ◽

2014 ◽

Vol 41 (2) ◽

pp. 23-26

Author(s):

MR Khandoker ◽

ZR Khan ◽

S Kawsar ◽

MI Khademul ◽

KAK Azad

Keyword(s):

Initial Study ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Skilled Manpower ◽

Neurolytic Block ◽

Upper Abdominal ◽

Transaortic Approach ◽

Plexus Block ◽

Suitable Technique ◽

Better Than

33 patients [13 female] with metastatic intractable upper Abdominal Cancer Pain were treated with celiac plexus neurolytic block with 60% alcohol. Aim of study is to observe the effectiveness of three different techniques of celiac plexus block, unilateral paravertibral, bilateral paravertibral and Paravertibral transaortic approach of celiac plexus blocks under C- arm guidance. Satisfactory pain relief occurs in all three techniques but out- come of transaortic approach a little better than other methods. Pain intensity was assessed by VRS and VAS Scale. Celiac plexus blocks are a suitable technique for upper abdominal visceral metastatic pain. Its effects are prolonged and also increase bowel movement, improve appetite and reduced morphine consumption. This is an initial study and numbers of subject are few. So more study required to get conclusive result. Skilled manpower and appropriate case selection is mandatory for successful results. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18800 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 23-26

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Celiac Plexus Blockade and Neurolysis: Ultrasound

10.1093/med/9780199908004.003.0033 ◽

2016 ◽

Author(s):

Samer N. Narouze

Keyword(s):

Ultrasound Guidance ◽

Terminally Ill ◽

Celiac Plexus ◽

Imaging Modalities ◽

Celiac Plexus Block ◽

Ultrasound Guided ◽

Radiology Suite ◽

Neurolytic Block ◽

Upper Abdominal ◽

Plexus Block

There has been a growing interest in ultrasound-guided celiac plexus blocks, especially neurolytic blocks, for terminally ill patients with upper abdominal malignancies. These patients are usually frail and difficult to transfer to the radiology suite. Ultrasound-guided celiac plexus neurolytic block can be performed at the bedside with appropriate monitoring. This chapter focuses on ultrasound guidance. It reviews the advantages of ultrasound compared with other imaging modalities in celiac plexus block as well as the step-by-step technique and how to avoid complications.

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