Percutaneous Ultrasound Long Axis (In-plane)-guided Approach: A Novel Technique for Celiac Plexus Neurolysis in Patients with Advanced Pancreatic Cancer

Abstract

Introduction:The primary objective is to investigate the feasibility of proposed percutaneous ultrasound long axis (LA; in-plane) guided approach for celiac plexus neurolysis (CPN) in patients with advanced pancreatic cancer. The present study also aimed to assess the outcome as well as to document complications specific to the proposed technique if any. Materials and methods: Celiac plexus neurolysis under LA ultrasound (USG) guidance was performed in thirty one patients (mean age of 58.2 ± 4.7 years) of either-sex (24 men and 7 women) suffering from chronic pain due to pancreatic cancer [visual analog scale (VAS) score > 4] not responding to any pharmacological treatment or in those where opioids-related adverse effects are poorly tolerated. Follow-up was done immediately after injection, first day, 1 week, 4 weeks and 12 weeks following intervention and on an as needed basis thereafter. Post-neurolysis and at each subsequent follow-up visit, pain scores, satisfaction rate and other complications were studied. Level of statistical significance was set at a p < 0.05. Results: At 12 weeks CPN under LA ultrasound guidance was associated with significant pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction (p < 0.05). There were no major peri-and/or postoperative complications. Conclusion: Celiac plexus neurolysis under LA USG guidance enhances effectiveness and was associated with better pain relief, reduced NSAIDS/ opioids consumption and improved patient satisfaction. Clinical significance: Celiac plexus neurolysis under LA USG guidance enhances effectiveness of pain relief and level of safety in patients with abdominal malignancies.

Untitled

“…In our study, 13.3% (2/15) had self-limiting diarrhea in the postoperative period. Chansoria et al [12] reported 64.5% (20/31) of increased defecation. Patient satisfaction scores and surgeon satisfaction score of our study were comparable with Elsabenny et al [5] and Bhatia et al [20], respectively.…”

“…Drug gets distributed into the fatty plane bathing the CP. The second approach as described by Chansoria et al [12], the curvilinear probe was kept in the longitudinal orientation, just below the xiphisternum in the midline, to identify the descending abdominal aorta and its branches such as CeT and SMA. The needling was done in caudocephalic direction, using in-plane needling to reach the needle tip between the CeT and SMA which forms the "Trident sign" along with the block needle.…”

“…In our study, only 26.6% (4/15) patients had significant hypotension (<20% drop in MAP) following CP block and others had hypotension but was not significant. Chansoria et al [12] reported that 33.25% (10/31) of their patients had hypotension and Elsabenny et al [5] reported 23.8% (5/21) and 14.2 % (3/22) with continuous segmental thoracic EA and GA, respectively. In our study, 13.3% (2/15) had self-limiting diarrhea in the postoperative period.…”

“…There is limited evidence for usage of these two blocks in combination to attain surgical anaesthesia during open palliative feeding jejunostomy [10]. Although SC TAP block can be performed easily by novice anaesthesiologists, the existing approaches of ultrasound guided CP block has a steep learning curve [11,12]. Hence, we proposed a novel supraceliac approach for ultrasound guided CP block in combination with Ultrasound guided SC TAP block for anaesthesia during open palliative feeding jejunostomy.…”