Celiac Plexus Block for Treatment of Pain Associated with Pancreatic Cancer: A Meta‐Analysis

Abstract

Pancreatic ductal adenocarcinoma has a high rate of neural invasion (80 to 100%) and can be associated with moderate to severe pain in pancreatic cancer. Treatment of pain with celiac plexus blockage (CPB) combined with the three-step ladder utilization of pharmaceutical analgesics following WHO guidelines is used, but the evidence in randomized controlled trials is inconsistent. This meta-analysis identified and compared seven randomized control trials of pain relief from pancreatic cancer, by treatment with medical management alone to celiac plexus blockade with medical management. While no evidence of potential publication bias was detected, group size and statistical power may account for some of the inconsistent conclusions. The combined CPB groups had a significantly lower pain score at 4 weeks, but significance was not maintained at 8 weeks. The combined CPB groups required significantly less drug use compared to the combined control groups treated with pharmaceutical analgesics.

Acute alcohol intoxication: uncommon complication associated to celiac plexus neurolysis during open surgical procedure in patient with refractory cancer pain. Case report

“…Maximum level was reached 15 minutes after injection, both in arterial and venous blood. Similarly, patient had decreased pressure levels at intraneural injection, and has again manifested such symptom in the PACU, with good response to fluid infusion, now associated to acute alcohol intoxication/inebriation, which have acted as marker of effective systemic absorption 8 . One should stress in this case the importance of following such patients in the PACU, not only as routine related to anesthetic technique, but also to evaluate and be familiar with…”

“…In the intraoperative approach, as decided by patient's surgical team, CPN is performed with injection of 10mL of 98% alcohol. Mean administered volume, regardless of the technique, is approximately 15mL 8 . Note that the volume administered to patient (40mL) was higher than that found in the literature, which may be related to intraoperative hypertension and complications detected at PACU, especially neurological ones associated to alcohol intoxication, similar to inebriation, tachycardia, facial flushing, cold sweating, agitation and confusion, dysarthria and motor changes.…”

“…Complications of such technique are rare, and adverse effects are, in their majority, reversible and responsive to treatment. Benefits of this method are related not only to pain relief, but also to decreased use of analgesics (and their respective adverse effects), in addition to improving quality of life not only of advanced disease patients [8][9][10] . Neurolysis, by interrupting nociceptive pathway, may indirectly change response to stress and disease-related behavior.…”

“…It is also worth stressing that pain and stress stimulate metastatic propagation and that an effective pain control or change in stress response may have a protective effect on the immune system. So, cancer patients' pain control is not only ethic, but may also improve their life expectancy [8][9][10] .…”

Percutaneous, computed tomography guided neurolysis using continuous radiofrequency for pain reduction in oncologic patients

“…[19] The questionnaires were recorded before the treatment, one week after treatment, and at the last follow-up (average follow-up 6 months).…”