Abstract No. 219 Rethinking median arcuate ligament syndrome: the role of celiac plexus block for diagnosis

Barbon, Dennis; Hsu, Richard; Noga, J. Thomas; Lazzara, Bryan; Miller, Todd S.; Stainken, Brian F.

doi:10.1016/j.jvir.2021.03.225

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“…3,8,9 Through rigorous patient selection and refinement of operative techniques to resect the median arcuate ligament and celiac plexus, our hospital has reported positive patient outcomes on postprandial pain, nausea, and vomiting. 10,11 Even with prudent patient selection for the procedure, this surgery is complex and requires aggressive pain management and control. 12 As widely reported, many MALS patients are considered chronic pain patients, and require effective pain management before, during, and after surgery to reduce acute postoperative pain.…”

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confidence: 99%

Evaluation of a pain management program for patients with median arcuate ligament syndrome

et al. 2023

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Objectives: Median arcuate ligament syndrome is a complex disorder potentially caused by variation in the position of the median arcuate ligament. Symptomology involves chronic abdominal pain, nausea, and malnourishment. Pain management modalities and short-term outcomes for patients undergoing operative surgery for median arcuate ligament syndrome have yet to be fully evaluated. Our hospital implemented a pain management consultation program in 2017 focused on perioperative pain management. The objective of this study is to assess if the introduction of a pain management consultation program concurrent with median arcuate ligament syndrome surgery impacts patient outcomes and post-operative pain management strategies in these patients. Methods: De-identified data was collected retrospectively from our hospital’s electronic medical records system, identifying median arcuate ligament syndrome patients and using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes from September 2017 to August 2021. Patients were grouped into the “consultation” cohort if they had scheduled and attended a pre-operative pain consultation. Pre-operative and discharge medications, pain scores, and demographics were collected to evaluate if the initiative impacted outcomes. Results: Median arcuate ligament syndrome patients who had a pre-operative pain management consultation had higher rates of pre-operative opioid (35.5%; p = 0.01) and non-opioid use (60.7%; p < 0.001). Patients without a pre-operative consultation that did not use opioids pre-operatively were more likely to be discharged on one or more opioids. Differences were also found for psychiatric medication at discharge ( p < 0.001) with patients receiving pain consultation indicating higher percentages of use. Conclusion: Special consideration on prescribing pain medication should be part of discharge planning for median arcuate ligament syndrome patients. Addition of a pain management consultation can aid in these decisions.

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