Effect of celiac plexus neurolysis for pain relief in patients with upper abdominal malignancy: A retrospective observational study and review of literature

Abstract

Background: Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant or non-responsive to the pharmacological management, hence minimal invasive pain intervention like celiac plexus neurolysis or splanchnic nerve rhizolysis may be required to relieve pain of such patients. Objective: The aim of this retrospective study is to assess the effect of celiac plexus neurolysis for pain relief in patients with upper gastro-intestinal malignancies. Study Design: This is a retrospective, observational study with short review. Methods: This retrospective observational study was done in the Pain Medicine unit from 2016 and November 2018. Ninety-four patients with upper abdominal malignancy and unrelenting pain, non-responsive or poorly responsive to pharmacological treatment as per WHO ladder of analgesics, received fluoroscopy-guided celiac plexus neurolysis (CPN). All the patients underwent celiac plexus neurolysis through Trans-Aortic approach and the primary outcome measure was pain as assessed with Visual Analogue Scale (VAS) ranging from 0 to 10; the secondary outcome measures were morphine consumption per day (M), quality of life (QOL) as assessed by comparing the percent of positive responses and complications, if any. These were noted and analyzed prior to intervention and then on day 1, and months 1, 2, 3, 4, 5, 6 following CPN. Results: Follow up was completed 6 months after the procedure. VAS score, daily morphine consumption, and the quality of life showed improvement for the duration of the study. There was some relapse in pain and deterioration in QOL during the fourth to sixth month of pain intervention due to disease progression. Some transient known side effects also occurred. Conclusion: Trans-Aortic celiac plexus neurolysis with low volume of alcohol is a safe procedure providing up to 6 months of pain relief and is an effective, well established, minimally invasive procedure for abdominal pain due to primary malignancy or metastatic spread.

Long-Term Analgesic Efficacy of Neurolytic Splanchnic Nerve Block via the Transintervertebral Disc Approach to Retrocrural Space: A Multicenter Retrospective Study

“…In the present study, the median NRS was less than 2 without a clinically noticeable increase in opioid dose until 6 months after the one-time NSNB, resulting in the long-term [17]. A retrospective study similar to the present study reported that fluoroscopic celiac plexus block in patients with upper abdominal cancer significantly decreased both the mean visual analog scale and mean oral morphine equivalent up to the 6 months from the block compared with pre-block data [4]. In addition to these two studies, there have been many others on celiac plexus block; however, it is difficult to compare the results of these studies owing to the difference in the patients' background, block technique, and implementation conditions among studies [10].…”

“…The celiac plexus nerve block relieves intractable cancer pain arising from the pancreas or other organs in close proximity, and the splanchnic nerve block is considered clinically equivalent to the celiac plexus block for analgesia [1][2][3]. The splanchnic nerve block has been shown to provide a long-lasting benefit for 70-90% of patients with pancreatic and intraabdominal cancers, with the benefit ranging from 50 days until the time of death [4]. Its analgesic effect may reduce the use of high-dose opioids, the prolonged administration of which have a medico-economic burden [5] and cause side effects such as somnolence, nausea, and constipation, etc., therefore, improving the patients' quality of life (QOL) [6][7][8][9].…”