Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain

Abstract

Palliative treatment, pain therapy and quality of life (QOL) are very important in pancreatic cancer patients. We evaluated the pain relieving efficacy, side effects and effects on QOL of neurolytic coeliac plexus blockade (NCPB) and splanchnic nerves neurolytic blockade (SNB) in body and tail located pancreatic cancer. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Coeliac group; GC, N = 19 were treated with coeliac plexus blockade, whereas the patients in splanchnic group; GS, N = 20 were treated with bilateral splanchnic nerve blockade. The VAS values, opioid consumption and QOL (Patient satisfaction scale=PSS, performance status scale=PS) were evaluated prior to the procedure and at 2 weeks intervals after the procedure with the survival rates. The demographic features were found to be similar. The VAS differences (difference of every control's value with baseline value) in GS were significantly higher than the VAS differences in GC on every control meaning that VAS values in GS decreased more than the VAS values in GC. GS patients were found to decrease the opioid consumption significantly more than GC till the 6th control. GS patients had significant improvement in PS values at the first control. The mean survival rate was found to be significantly lower in GC. Two patients had severe pain during injection in GC and 5 patients had intractable diarrhoea in GC. Comparing the ease, pain relieving efficacy, QOL-effects of the methods, splanchnic nerve blocks may be an alternative to coeliac plexus blockade in patients with advanced body and tail located pancreatic cancer.

Pain Management in Pancreatic Cancer

“…Additionally, the authors found a beneficial effect on mood and quality of life. These findings have been corroborated in other studies; one [19] showed higher mean survival rates in the group with greater pain reduction, and another [34] showed an improvement in quality of life in NCPB groups compared to medical management alone. In contrast, other studies have not been able to reproduce similar results [27,31,35].…”

“…Their results showed that there was no difference in analgesic efficacy with respect to recurrent and residual (celiac or nonceliac) pain between the three, and that neurolytic celiac plexus block gave complete visceral pain relief in 70–80% of patients immediately and in up to 60–75% of patients until death. In contrast, when Suleyman et al [19] compared the transaortic celiac plexus block with splanchnic nerve block in a prospective randomized trial in patients with carcinoma of the body and tail of the pancreas, they found that splanchnicectomy provided greater pain relief and decreased opioid consumption when compared to NCPB. Although there have been only a few published case series and a retrospective study [20-23] regarding use of endoscopic-ultrasonography (EUS) guided CPN since the first report in 1995 [19], a recent review evaluated EUS-guided CPN to be 72.54% effective in pancreatic cancer patients [24].…”

“…In contrast, when Suleyman et al [19] compared the transaortic celiac plexus block with splanchnic nerve block in a prospective randomized trial in patients with carcinoma of the body and tail of the pancreas, they found that splanchnicectomy provided greater pain relief and decreased opioid consumption when compared to NCPB. Although there have been only a few published case series and a retrospective study [20-23] regarding use of endoscopic-ultrasonography (EUS) guided CPN since the first report in 1995 [19], a recent review evaluated EUS-guided CPN to be 72.54% effective in pancreatic cancer patients [24]. Further, EUS-guided CPB and CPN have also been reported to have low morbidity, with complication rates at 1.6% and 3.2%, respectively [25].…”

Pain Management in a Patient with Pancreatic Cancer and Substance Use Disorder

“…Splanchnic plexus neurolysis is an effective technique that can potentially improve pain control and quality of life in pancreatic cancer [16]. The efficacy of thoracic splanchnic nerve or celiac ganglion neurolytic blocks have been established for the management of pain in upper gastrointestinal tumors in various studies.…”

The role of interventional oncology in the palliative care of cancer patients

“…When NCPB was compared with splanchnic nerve neurolytic block (SNB) in 39 patients with head or tail pancreatic cancer it was found that SNB had significantly better impact on pain relief, QOL and analgesic consumption until the end of patients' lives [58]. Another study assessed QOL at 6 months in patients undergoing C-arm guided NCPB compared with splanchnic nerve neurolysis in patients with inoperable upper gastrointestinal tract tumors and with severe uncontrolled pain; the findings showed that splanchnic nerve block had superior results compared with celiac plexus block as more patients had good analgesic response to weak opioids and improvement in the social and cognitive subscales on QOL assessments [59].…”