Pain Outcomes in Patients Undergoing CT-Guided Celiac Plexus Neurolysis for Intractable Abdominal Visceral Pain

Abstract

The purpose of this study was to assess outcomes in patients who have undergone celiac plexus neurolysis (CPN) as treatment for refractory abdominal visceral pain at a tertiary care medical center. This study involved retrospective analysis of all patients who had undergone computed tomography (CT)-guided CPN over a 7-year period, as identified in the medical record. Cases were categorized into 1 of 3 groups-group 1: patients getting at least moderate improvement in pain but with improvements subsiding within 2 days; group 2: patients with some sustained pain relief but still requiring heavy doses of narcotics; group 3: patients with major or complete sustained reduction in pain where the narcotic dose was able to be reduced. One hundred thirty-eight cases were identified, 51 of which had no or insufficient follow-up, leaving 87 cases for analysis. Of the 87 cases, 31 (36%) were categorized as group 1, 21 (24%) as group 2, and 35 (40%) as group 3. There were no statistical differences in outcomes based on patient age, gender, time since diagnosis, or type of cancer. Documented postoperative complications were diarrhea (11 cases) and 1 case each of obtundation, hypotension, and presyncopal event. We conclude that patients undergoing CT-guided CPN for abdominal visceral pain achieve moderate or major short-term pain relief in a majority of cases. The procedure is safe with minimal complications.

CT-Guided Coeliac Plexus Neurolysis in Patients with Intra-Abdominal Malignancy: A Retrospective Evaluation of 52 Palliative In-Patients

“…After the first and second CPN we showed major pain relief of current pain, which was independent of the intra-abdominal malignancy. This supports previous literature that showed CPN as an effective procedure for the management of CAP [ 4 , 5 , 24 ]. Moreover, a reduction was found in the intensity of BTcP, independent of the number of procedures or pain intensity prior to the procedure.…”

“…Despite multimodal pain management strategies in these patients, CAP and BTcP are still common and have a major impact on the patient’s disability and quality of life [ 3 , 17 , 24 ]. In this context, CPN is a palliative intervention with the aim to reduce intractable pain and narcotic requirements [ 4 ].…”

Pain Outcomes After Celiac Plexus Block in Children and Young Adults with Cancer

“…C eliac plexus block (CPB) is an invasive technique used for visceral upper abdominal pain, 1 most commonly reported for pancreatic cancer, and also described for pancreatitis, cirrhosis, inflammatory bowel disease, and cancers of the colon, liver, stomach, intestine, gallbladder, ovary, esophagus, lung, and appendix. 2,3 CPB has also been employed more broadly for refractory hypertension and postoperative pain. [4][5][6] Studies have supported earlier use, such as at the time of attempted surgical resection in pancreatic cancer, regardless of preexistent pain, or before aggressive opioid dose escalation.…”

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

“…Although several studies have shown that NCPB significantly relieves certain types of visceral pain, pain relief is not guaranteed in all cases. Prior studies have reported that 40%-90% of the patients benefit from this intervention, and the efficacy of pain relief after NCPB may vary among patients [4][5][6][7][8][9][10]. Thus, it is important to identify the factors associated with the effectiveness of NCPB, as this will enable physicians to determine whether the procedure will benefit their patients.…”