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

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

JAMA ◽

10.1001/jama.291.9.1092 ◽

2004 ◽

Vol 291 (9) ◽

pp. 1092 ◽

Cited By ~ 321

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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A comparison of percutaneous and endoscopic-guided celiac plexus block/neurolysis in pancreatic cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15767 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15767-e15767 ◽

Cited By ~ 1

Author(s):

Swetha Kambhampati ◽

Elizabeth A. Sugar ◽

Joseph M. Herman ◽

Michael A. Erdek ◽

Eun Ji Shin ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Pain Control ◽

Rating Scale ◽

Statistical Significance ◽

Numeric Rating Scale ◽

Celiac Plexus ◽

Celiac Plexus Block ◽

Post Procedure ◽

Plexus Block

e15767 Background: Celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are options for pain control in pancreatic cancer. Conventionally they are performed percutaneously (PC) with fluoroscopic or CT guidance. However endoscopic ultrasound (EUS) guidance is being increasingly used. The aim of this retrospective study is to compare PC-guided and EUS-guided CPB/CPN for pain control. Methods: Our retrospective cohort study included pancreatic cancer patients who underwent CPN/CPB for pain control from 2008 to 2015 at Johns Hopkins. Patients were assessed immediately post-procedure and at 1 month. Patients were selected using CPT and ICD diagnosis code guided searches of the EHR. Pain intensity was assessed using a Numeric Rating Scale (NRS). A response was defined as a decrease in NRS scores by = > 3 points. The validated FACT-Hep score was used to assess quality of life (QOL). Opiate usage was converted into morphine dosage equivalents. Wilcox rank-sum and Fisher’s exact test were used to compare the EUS and PC cohorts. Results: Of 107 patients, 46 (43%) had EUS-CPN, 57 (53%) PC-CPN, and 4 (4%) PC-CPB. 10 patients had procedural complications (7% EUS and 11% PC, p = 0.51) with the most common being chronic diarrhea. The baseline median NRS score was 7 with significantly higher scores for those receiving EUS compared to PC (9 vs 7, p < 0.001). Immediately post-procedure, more PC patients (87%) had a response when compared to EUS patients (72%), although it did not reach statistical significance (p = 0.08). By one month, there was no difference in response rates. (43% CPN vs 34% EUS, p = 0.42) FACT-Hep score declined significantly in all patients with a median drop of 8 points at 1 month and no difference between PC and EUS (9 vs 8, p = 0.46). There was no difference in opiate usage at 1 month (88% PC vs 93% EUS, p = 0.51). Conclusions: Both EUS and PC-guided CPN were effective at reducing post-procedural pain in pancreatic cancer patients but their effectiveness waned by 1 month. EUS did have slightly fewer complications although PC did have slightly higher rates of response post-procedurally. QoL declined and opiate usage was unchanged in both groups. Both procedures had temporary efficacy and need further evaluation.

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