The Effectiveness of Alcohol Versus Phenol
Based Splanchnic Nerve Neurolysis for the
Treatment of Intra-Abdominal Cancer Pain

Koyyalagunta, Dhanalakshmi; Engle, Mitchell P.; Yu, Jun; Feng, Lei; Novy, Diane M.

doi:10.36076/ppj/2019.19.281

Cited by 68 publications

(48 citation statements)

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“…Neurolysis of retrocrural splanchnic nerves under fluoroscopy guidance is a commonly used strategy, and we used the same technique in our study. 20 Chemical neurolysis is generally achieved using alcohol (50% to 100%) or phenol (5% to 10%) that provides effective pain control for 3 to 6 months. 21,22 No significant difference in efficacy between alcohol and phenol was reported, while the risk of neuritis, which is one of the major side effects of this procedure, was found to be lower with phenol use.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 No significant difference in efficacy between alcohol and phenol was reported, while the risk of neuritis, which is one of the major side effects of this procedure, was found to be lower with phenol use. 20,23 Therefore, we preferred 6% phenol solution for our patients. To date, several studies separately examined celiac neurolysis and splanchnic neurolysis for cancer-related pain of the upper abdomen.…”

Section: Discussionmentioning

confidence: 99%

“…26 However, very few studies directly compared splanchnic vs celiac neurolysis so far. 18,20,27 Some reported better analgesic efficacy, reduced opioid use, decreased frequency of complications, as well as improved quality of life with splanchnic nerve neurolysis as compared to celiac plexus neurolysis. 18,27 In addition, splanchnic block was found to be associated with longer pain relief effect when compared to celiac plexus block in chronic abdominal pain not related to cancer.…”

Section: Discussionmentioning

confidence: 99%

“…28 In the retrospective study by Koyyalagunta et al, the involvement of the celiac plexus was not a factor that altered the efficacy of splanchnic neurolysis. 20 The anatomy of the celiac plexus may undergo significant changes due to underlying malignant condition or enlarged celiac lymph nodes in patients with advanced cancer, leading to challenges in accessing the celiac ganglia or inadequate diffusion of the neurolytic agent. [15][16][17] Side effects observed in our study included selflimiting hypotension and diarrhea/increased stool frequency, in addition to temporary neuritis in one patient; and we believe that such effects may be considered minor complications/side-effects.…”

Section: Discussionmentioning

confidence: 99%

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<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

Comlek¹

2020

JPR

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Background/Aims In most instances of abdominal pain associated with pancreatic cancer, pain may become refractory to increasing doses of narcotics. Celiac plexus neurolysis represents an option; however, altered celiac plexus anatomy may render this treatment infeasible or ineffective, where splanchnic nerve neurolysis may represent another option. This study aimed to investigate the outcomes of splanchnic neurolysis in pancreatic cancer patients not responsive to celiac plexus neurolysis. Patients and Methods Among all 84 patients who underwent celiac plexus neurolysis for pancreatic cancer pain during the study period, 34 patients did not respond and underwent splanchnic nerve neurolysis under fluoroscopic guidance and thus included in this retrospective study. Stage IV, III, and II disease was present in 38.2%, 47.1%, and 14.7% of the patients. During the study, 88.2% were receiving chemotherapy, whereas none were on radiotherapy. Data for daily narcotic dose equivalents and Visual Analogue Scale (VAS) scores during outpatient visits at baseline, 2 weeks, 2 months, and 3 months were extracted. Results Pain response rates were 76.5%, 84.4%, and 71.0%, at 2 weeks, 2 months, and 3 months, respectively. A significant and dramatic reduction was seen in VAS scores at 2 weeks (2.8±1.2 versus 6.3±1.1, p<0.001), and this significant decline was maintained for 3 months. Similarly, a significant and dramatic reduction was seen in daily narcotic need at 2 weeks (20.8±32.9 versus 93.4±86.2 mg, p<0.001), which was also maintained during the 3-month follow-up. The procedure was generally well tolerated. Conclusion Findings of this study suggest that splanchnic neurolysis represents a durable and effective option for pain control in pancreatic cancer patients in whom the neurolysis of the celiac plexus is ineffective. However, these conclusions refer to only preliminary single-center results in a selected patient group; thus, further large studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

Comlek¹

2020

JPR

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“…Several studies have investigated the predictive factors for several years. However, these studies are insufficient for establishing the factors because other potential factors exist but have not been illuminated, and the roles of some specific factors are still debated [ 2 , 7 , 10 - 16 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study

et al. 2021

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Background Prior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain. Methods A retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB. Results Among the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB. Conclusions Celiac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

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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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The Effectiveness of Alcohol Versus Phenol Based Splanchnic Nerve Neurolysis for the Treatment of Intra-Abdominal Cancer Pain

Cited by 68 publications

References 0 publications

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

<p>Pain Control with Splanchnic Neurolysis in Pancreatic Cancer Patients Unresponsive to Celiac Plexus Neurolysis</p>

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study

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

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