Celiac Plexus Blockade for a 3-Year-Old Boy With Hepatoblastoma and Refractory Pain

In the management of pain due to visceral malignancy (especially pancreatic carcinoma) in adults, neurolytic celiac plexus blockade has emerged as an effective pain management procedure1,2; in the management of severe pain due to pancreatic carcinoma, it is regarded by many as the technique of choice.3 In this procedure, a nerve-destructive agent such as ethanol or phenol is injected percutaneously, usually from a posterolateral approach, immediately around the aorta and vena cava at the level of origin of the celiac artery. When performed for pancreatic cancer pain, celiac blockade provides good or excellent pain relief in 85% to 97% of cases, generally for 6 months to 2 years.

Download Full-text

Celiac Plexus Neurolysis (CPN) in the Treatment of Refractory Pain of Pancreatic Cancer (PCA): Site Specific Response to Therapy

Gastrointestinal Endoscopy ◽

10.1016/s0016-5107(05)01417-3 ◽

2005 ◽

Vol 61 (5) ◽

pp. AB273 ◽

Cited By ~ 2

Author(s):

Marc F. Catalano ◽

Urooj Ahmed ◽

Shailendra S. Chauhan ◽

Sandeep N. Patel ◽

Joseph E. Geenen

Keyword(s):

Pancreatic Cancer ◽

Response To Therapy ◽

Celiac Plexus ◽

Specific Response ◽

Site Specific ◽

Refractory Pain

Download Full-text

Quadratus Lumborum Block for Back Pain Related to Pancreatic Cancer – A Report of Two Cases

Pain Management Case Reports ◽

10.36076/pmcr.2018/2/197 ◽

2018 ◽

pp. 197-203

Author(s):

Uri Hochberg

Keyword(s):

Pancreatic Cancer ◽

Back Pain ◽

Pain Management ◽

Pain Relief ◽

Cancer Pain ◽

Myofascial Pain ◽

Celiac Plexus ◽

World Health ◽

Quadratus Lumborum Block ◽

Quadratus Lumborum

Pancreatic cancer is often accompanied by severe pain. Patients typically experience upper abdominal and/or thoracolumbar back pain. For those cases failing to respond to standard medical management, as suggested by the World Health Organization, interventions designated at interruption of the sympathetic axis (such as neurolysis of the celiac plexus or splanchnic nerves) have been shown to be efficacious. Other than axial drug delivery, there are few interventional alternatives in patients with pancreatic cancerrelated pain. There is little knowledge regarding the therapeutic effects of treating peripheral somatic soft tissue among oncological patients. Here we report on 2 such patients, whose back pain improved following a quadratus lumborum block. Two patients diagnosed with pancreatic cancer presented with severe back pain. The pain pattern and patients’ physical exams were compatible with myofascial pain arising from the quadratus lumborum muscle, possibly irritated by the abdominal tumor. Advanced pain management, including long- and short-acting opioids and adjuvants, as well as celiac plexus neurolytic block, failed to provide satisfactory pain relief. Given the apparent muscular origin of the pain, a bilateral ultrasound-guided quadratus lumborum block was performed. Four weeks post procedure, the 2 patients reported substantial pain relief supported by reduced consumption of pain medication and improved functional status. No adverse events or complications were observed in either case. In the patients described here, quadratus lumborum block proved to be safe and efficacious in alleviating back pain related to pancreatic cancer. In our opinion, clinicians should be aware of the possible contribution of a myofascial component to pain in pancreatic cancer and in cancer-related pain in general. Key words: Quadratus lumborum block, cancer pain, pancreatic cancer, pain control, myofascial pain syndrome, interventional pain management

Download Full-text

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.

Download Full-text

Mo1477 Pain Relief in Pancreatic Cancer: Can the Outcomes of EUS-Guided Celiac Plexus Neurolysis (EUS-CPN) Be Improved?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2015.03.1641 ◽

2015 ◽

Vol 81 (5) ◽

pp. AB434

Author(s):

Muhammad K. Hasan ◽

Ji Young Bang ◽

Bryce Sutton ◽

Udayakumar Navaneethan ◽

Amy L. Logue ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pain Relief ◽

Celiac Plexus

Download Full-text

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

Download Full-text

Single-needle Celiac Plexus Block

Anesthesiology ◽

10.1097/00000542-199712000-00007 ◽

1997 ◽

Vol 87 (6) ◽

pp. 1301-1308 ◽

Cited By ~ 42

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.

Download Full-text

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.

Download Full-text

The Efficacy and Safety of Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pain in Patients with Pancreatic Cancer

Gastroenterology Research and Practice ◽

10.1155/2012/503098 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Anna Wiechowska-Kozłowska ◽

Klaudiusz Boer ◽

Maciej Wójcicki ◽

Piotr Milkiewicz

Keyword(s):

Pancreatic Cancer ◽

Endoscopic Ultrasound ◽

Severe Pain ◽

Advanced Pancreatic Cancer ◽

Substantial Improvement ◽

Celiac Plexus ◽

Complete Disappearance ◽

Unresectable Pancreatic Cancer ◽

Efficacy And Safety ◽

Point Scale

Introduction.Celiac plexus neurolysis is used in pain management of patients with advanced and unresectable pancreatic cancer. We retrospectively analyzed efficacy and safety of endoscopic ultrasound- (EUS-) guided celiac plexus neurolysis in patients treated in our unit.Methods.Twenty nine subjects with unresectable pancreatic cancer and severe pain despite pharmacological treatment underwent EUS-guided celiac plexus neurolysis with 98% ethanol. Patients scored their pain according to a 0–10 point scale and were interviewed 1-2 weeks and 2-3 months after the procedure.Results.Twenty five (86%) patients reported improvement in their pain at 1-2 weeks following the procedure. Of these, 7 (24%) reported substantial improvement (decrease in pain by more than 50%) and 4 (14%) complete disappearance of pain. Pain relief was still present in 76% of patients after 2-3 months. Treatment-related side effects included hypotonia in 1 patient, severe pain immediately postprocedure in 2 patients, and short episodes of diarrhea in 3 patients.Conclusion.Endoscopic ultrasound- (EUS-) guided celiac plexus neurolysis is a safe and effective treatment of severe pain from advanced pancreatic cancer.

Download Full-text