An open randomised comparison of the clinical effectiveness and costs of protocol driven opioid analgesia, celiac plexus block, or thoracoscopic splanchnicectomy for pain relief in patients with abdominal malignancy

2012 ◽  
Author(s):  
Colin Johnson
Keyword(s):  
Pain Relief ◽  
Clinical Effectiveness ◽  
Celiac Plexus ◽  
Opioid Analgesia ◽  
Celiac Plexus Block ◽  
Thoracoscopic Splanchnicectomy ◽  
Abdominal Malignancy ◽  
Plexus Block

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

2000 ◽  
Vol 92 (2) ◽  
pp. 347-347 ◽  
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.

Single-needle Celiac Plexus Block 

1997 ◽  
Vol 87 (6) ◽  
pp. 1301-1308 ◽  
Author(s):  
Marcello De Cicco ◽  
Mira Matovic ◽  
Luca Balestreri ◽  
Augusto Fracasso ◽  
Sandro Morassut ◽  
...  
Keyword(s):  
Pain Relief ◽  
Celiac Artery ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Ct Guided ◽  
Needle Position ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Plexus Block

Background The "single-needle" celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated. Methods Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long-lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed. Results The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P < 0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P < 0.01). A significant difference in long-lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P < 0.01). No patients showing two or one quadrant with contrast had long-lasting pain relief. Conclusions These findings suggest that, when the celiac area is free from anatomic distortions, and the single-needle neurolytic celiac plexus block technique is used, the needle tip should be positioned cephalad to the celiac artery to achieve a wider neurolytic spread. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia.

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

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.

scholarly journals Effect of Neurolytic Celiac Plexus Block on Pain Relief, Quality of Life, and Survival in Patients With Unresectable Pancreatic Cancer

JAMA ◽  
2004 ◽  
Vol 291 (9) ◽  
pp. 1092 ◽  
Author(s):  
Gilbert Y. Wong ◽  
Darrell R. Schroeder ◽  
Paul E. Carns ◽  
Jack L. Wilson ◽  
David P. Martin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pancreatic Cancer ◽  
Pain Relief ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Unresectable Pancreatic Cancer ◽  
Plexus Block
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