Pain management of pancreatic carcinoma: a review

Lebovits, Allen H.; Lefkowitz, Mathew

doi:10.1016/0304-3959(89)90106-1

Cited by 87 publications

(38 citation statements)

References 37 publications

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“…Earlier studies on percutaneous CPN showed conflicting results. In one meta-analysis [12] , percutaneous CPN resulted in sufficient pain relief while another metaanalysis [13] concluded that the CPN data were insufficient to judge the efficacy and long-term morbidities. In a more recent meta-analysis on CPN [4] where the cancer type was identified in 1117 patients (63% of which were pancreatic), 89% of patients reported good-to-excellent pain relief during the first couple of weeks after the CPN procedure.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided celiac plexus neurolysis

Soweid¹,

Azar²

2010

WJGE

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Endoscopic celiac plexus neurolysis (CPN) has become the procedure of choice for the management of pa tients with pancreatic cancer and abdominal pain un responsive to medical treatment. It is necessary to differentiate between CPN and endoscopic celiac plexus block performed in patients with benign disease. In this review we describe the technique of this procedure with special emphasis on technical details.

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Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound-guided celiac plexus neurolysis

Soweid¹,

Azar²

2010

WJGE

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“…However, recent reviews of the efficacy of NCPB have reached conflicting conclusions. Some investigators affirm the efficacy of NCPB for pancreatic cancer pain, 34 but others believe that its effectiveness is not yet proven. 35 Recently, it has been emphasised that only an incomplete spread may occur even when the coeliac area seems free from regional anatomical distortions.…”

Section: Clinical Efficacymentioning

confidence: 99%

Coeliac plexus neurolysis for upper abdominal malignancies using an anterior approach: review of the literature

Ghai

Kumar

Wadhera³

2015

Southern African Journal of Anaesthesia and Analgesia

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Background: Coeliac plexus neurolysis (CPN) helps to diminish pain arising from malignancy of upper abdominal viscera. Imaging modalities have increased the success rates by enhancing technical accuracy including fluoroscopy, computed tomography and ultrasound. Advancement in the imaging modalities used has helped in the accurate depiction of anatomy and position of the needle tip. Methods: In an anterior approach, the patient lies supine and the needle is inserted through the anterior abdominal wall into the retropancreatic space. The needle often traverses the stomach, liver or pancreas before reaching the coeliac plexus due to anatomical considerations. The literature has been reviewed regarding various imaging modalities using an anterior approach to coeliac plexus block with regard to success rate, improvement in pain scores, duration of pain relief and analgesic consumption. Results: Successful pain relief in abdominal malignancies with an anterior approach using various imaging modalities varies between 54% and 94% of patients. Following neurolysis, many patients can be weaned off opioids. This procedure improves quality of life and reduces the risk of drug-related side effects. The duration of pain relief after an anterior approach is six to eight weeks. Conclusion: The use of various imaging modalities in an anterior approach has improved the technical accuracy in reaching the coeliac plexus, thereby avoiding the needle piercing crucial structures and avoiding deposition of drug in the retrocrural space, thereby reducing the risk of neurological complications. Coeliac plexus neurolysis via an anterior approach using different imaging modalities does not completely abolish pain, rather it diminishes pain, helping to reduce opioid requirements and improving survival in patients with upper abdominal malignancy.

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“…Conservative methods of treatment are unsatisfactory and their side effects lead to serious somatic and mental comorbidities (1,2,3). Non-steroidal anti-inflammatory drugs (NSAIDs), opioids, or neurolysis of the splanchnic ganglion have been 43 Videothoracoscopic simultaneous bilateral posterior splanchnicectomy -initial report proven to be insufficient and failed to provide long-lasting relief (3,4).…”

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confidence: 99%

Videothoracoscopic Simultaneous Bilateral Posterior Splanchnicectomy - Initial Report

Stefaniak¹,

Reszetow²,

Żemojtel³

et al. 2007

Polish Journal of Surgery

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Chronic pain syndrome (CPS), accompanying pancreatic diseases, especially chronic pancreatitis and pancreatic cancer requires the strongest analgesic agents and is considered difficult to manage. Conservative methods are unsatisfactory and their side effects lead to serious somatic and mental comorbidities. The aim of the study was to perform an initial evaluation of videothoracoscopic bilateral splanchnicectomy using the posterior approach, as the method of treatment in cases of advanced pancreatic cancer. Material and methods. During the period between May and July 2005 there were 10 simultaneous bilateral videothoracoscopic splanchnicectomies (BVSPL) performed in patients with chronic pain syndrome, due to advanced pancreatic cancer, at the Department of General, Endocrinological and Transplant Surgery, Medical University of Gdańsk. Results. All patients were discharged from the hospital on the second postoperative day. Subjective pain measured by the VAS scale changed from 84.3±7.6% before the operation to 25.3±5.3% during the first and second postoperative days. The median follow-up of patients was approximately 4 months (ranging between 2 and 6 months). The intensity of pain 2, 6, and 12 weeks after the procedure was 28.7±4.7%, 30.3±5.4% and 36.2±4.7%, respectively. Conclusions. This is the first description of this safe and feasible method in the Polish surgical literature. The surgical procedure can be safely performed in most surgical departments equipped with videoscopic instruments. Moreover, the short learning curve enables surgeons to perform this procedure well after a short training period. In combination with good results concerning subjective pain reduction, it can be concluded that BVSPL should be incorporated into the spectrum of surgical procedures in most surgical departments in Poland.

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Pain management of pancreatic carcinoma: a review

Cited by 87 publications

References 37 publications

Endoscopic ultrasound-guided celiac plexus neurolysis

Endoscopic ultrasound-guided celiac plexus neurolysis

Coeliac plexus neurolysis for upper abdominal malignancies using an anterior approach: review of the literature

Videothoracoscopic Simultaneous Bilateral Posterior Splanchnicectomy - Initial Report

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