Bleeding Complications in Patients Undergoing Celiac Plexus Block

Warner, Nafisseh S.; Moeschler, Susan M.; Warner, Matthew A.; Hoelzer, Bryan C.; Eldrige, Jason S.; Mauck, William D.; Watson, James C.; Gazelka, Halena M.; Lamer, Tim J.; Kor, Daryl J.; Hooten, W. Michael

doi:10.1097/aap.0000000000000409

Cited by 13 publications

(9 citation statements)

References 15 publications

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“…13 The incidence of bleeding requiring a transfusion has been reported as 1.2% and the incidence of paraplegia as 0.15% in large retrospective case series. 14,15 To the authors' knowledge, there has not been a RCT comparing safety and efficacy of percutaneous vs endoscopic CPB in the setting of malignancy.…”

Section: Results Of a Systematic Review By Zhong Et Al Were Consistentmentioning

confidence: 99%

“…Common adverse events are transient diarrhea and hypotension (9% and 8%, respectively) 12 likely due to unopposed parasympathetic activity following predominant sympathetic blockade 13 . The incidence of bleeding requiring a transfusion has been reported as 1.2% and the incidence of paraplegia as 0.15% in large retrospective case series 14,15 …”

Section: Introductionmentioning

confidence: 99%

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A retrospective case series of patients who have undergone coeliac plexus blocks for the purpose of alleviating pain due to intra‐abdominal malignancy

2020

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Background: Coeliac plexus block (CPB) is an interventional pain management option for patients with pancreatic or other upper abdominal malignancy. Aims: To assess the safety, utilization, and outcomes of CPBs in the local context. Methods and Results: We conducted a retrospective case series of all patients with cancer who underwent CPB at 4 Sydney teaching hospitals from March 2010 to February 2016. We recorded baseline demographic data, details of the injectate, procedural approach and survival, as well as pain scores and analgesic use at 4 time points of interest. Thirty-nine procedures were performed during the study period. Twenty-four were performed endoscopically, 14 were performed via a bilateral percutaneous posterior approach by Pain Specialists or Radiologists and 1 was performed intraoperatively by a Surgeon. Patients had experienced pain for a mean of 17 weeks prior to CPB. Prior to CPB, the mean pain score was 8.8 out of 10. The mean pain score was reduced at 48 hours, 2 weeks, and 4 weeks following CPB (P < .01). The mean oral morphine equivalent daily dose prior to CPB was 362 mg which was reduced at 48 hours and 2 weeks but increased at the 4 weeks following CPB. One patient developed a bacteremia but otherwise no complications were observed. Conclusion: CPB is performed by a number of approaches and is well tolerated. The approach selected appears to depend on patient anatomy, preference, and availability of local expertise. Local clinicians could consider CPB earlier in the management of malignant epigastric pain.

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Section: Results Of a Systematic Review By Zhong Et Al Were Consistentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A retrospective case series of patients who have undergone coeliac plexus blocks for the purpose of alleviating pain due to intra‐abdominal malignancy

2020

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“…85 86 A positive examination indicates that the patient has at least 300-500 mL of free fluid in the peritoneal space. 87 This amount of fluid following abdominal surgery is rarely benign and almost always indicates ongoing hemorrhage. An exception to this situation is intra-abdominal fluid extravasation (IAFE) following hip arthroscopy.…”

Section: Fast Examinationmentioning

confidence: 99%

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

Haskins

Bronshteyn

Perlas

et al. 2021

Reg Anesth Pain Med

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Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine (ASRA) commissioned this narrative review to provide recommendations for POCUS. The guidelines were written by content and educational experts and approved by the Guidelines Committee and the Board of Directors of the ASRA. In part I of this two-part series, clinical indications for POCUS in the perioperative and chronic pain setting are described. The clinical review addresses airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma examination and focused cardiac ultrasound for the regional anesthesiologist and pain physician. It also provides foundational knowledge regarding ultrasound physics, discusses the impact of handheld devices and finally, offers insight into the role of POCUS in the pediatric population.

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“…1,146 Recently, small retrospective reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures including joint injections, facet procedures, ESIs, percutaneous spinal cord stimulator trials and implantations, celiac plexus blocks, and intrathecal drug delivery systems have been published. [6][7][8][9] Unfortunately, based on the inherent limitations of retrospective analyses and the small number of patients receiving NSAIDs, the ability to draw clinical conclusions and imply the safe performance of these interventional pain procedures while continuing NSAIDs and ASA is limited. Bleeding complications in individuals undergoing percutaneous spinal cord stimulator trial implantations were examined in 101 patients who had continued NSAIDs.…”

Section: Procedural Recommendations: Overviewmentioning

confidence: 99%

“…[3][4][5] The current ASRA guidelines for the placement of epidural and spinal catheters do not recommend cessation of these antiplatelet agents for epidural procedures, nor do the guidelines differentiate between interventional pain procedures and perioperative regional anesthesia blocks. 2 The development of new anticoagulants and antiplatelet medications as well as the recent publications evaluating bleeding complications in patients undergoing specific interventional spine and pain procedures including facet procedures, ESIs, percutaneous spinal cord stimulator trials and implantations, celiac plexus blocks, and intrathecal drug delivery systems [6][7][8][9] necessitates updated guidelines. Hence, the ASRA Board of Directors recommended that the guidelines committee develop updated guidelines for pain medicine interventions.…”

mentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

Narouze

Benzon

Provenzano³

et al. 2017

Regional Anesthesia and Pain Medicine

116

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The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated periodically with consideration of new evidence.

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Bleeding Complications in Patients Undergoing Celiac Plexus Block

Abstract: This study suggests that CPBs may be safely performed in patients receiving aspirin and/or NSAID therapy.

Cited by 13 publications

References 15 publications

A retrospective case series of patients who have undergone coeliac plexus blocks for the purpose of alleviating pain due to intra‐abdominal malignancy

A retrospective case series of patients who have undergone coeliac plexus blocks for the purpose of alleviating pain due to intra‐abdominal malignancy

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

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