Paraplegia after celiac plexus neurolysis in a patient with pancreatic cancer - A case report and literature review -

Kim, Sung Hoon; Jang, Ki-Mo; Cheon, Bo Kyung; Lim, Jeong Ae; Woo, Nam Sik; Kim, Hae Kyung; Kim, Jae‐Hun

doi:10.17085/apm.2019.14.1.85

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…До недоліків -ризик виникнення дисциту, грижі міжхребцевого диска або більш грізне ускладнення -пошкодження спинного мозку, спинномозкових корінців безпосередньо голкою або витоком нейролітичного агента в субарахноїдальний простір, уведення спирту в передню спинномозкову артерію або артерію Адамкевича чи їх токсичне ураження [16]. І хоча частота неврологічних ускладнень становить менше за 1 % [17,18], неодноразово були описані випадки виникнення транзиторної чи стійкої нижньої параплегії після нейролізису ЧС [19].…”

Section: рисунок 4 демонстрація двобічного заднього паравертебральног...unclassified

Minimally invasive interventions on celiac plexus in patients with persistent abdominal pain caused by pancreatic cancer

Eroshkin,

Romanukha

2024

INJ

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Background. Chronic abdominal pain is common in 50 % of patients with intra-abdominal malignancies and has a huge impact on quality of their lives. As the number and doses of systemic analgesics increase, so does the frequency of side effects that can further worsen functional status, which is important for this cohort of patients who have a five-year survival rate of only 8 %. The purpose of the study: to assess the efficacy and safety of computed tomography-guided celiac plexus neurolysis as a method of reducing persistent, severe pain in patients with pancreatic cancer that affects their functional status. Materials and methods. The analysis of the results of 17 interventional procedures on the celiac plexus in 16 participants was conducted, sympatholysis was performed twice in one patient. Inclusion criteria: pancreatic cancer with persistent pharmacoresistant neuropathic abdominal pain for ≥ 3 months, which did not respond to medications, including opioids, anti-inflammatory drugs, and other conservative methods of treatment. Age of patients was 39 to 72 years (mean of 62.6 ± 8.2 years), 10 (62.5 %) research participants were male and 6 (37.5 %) were female. Results. Interventions were successfully performed for all patients on the first attempt. There were no cases of perforations of hollow organs, damage to blood vessels, pleural sinuses, or other structures of the abdominal and thoracic cavities. No neurological complications were recorded, and no one required blood transfusion. All study patients had a significant reduction in pain on the visual analogue scale compared to baseline, both one week after the procedure, from 9.7 ± 0.6 to 4.7 ± 1.4 (P < 0.001), and in six months, from 9.7 ± 0.6 to 4.1 ± 1.4 (P < 0.001). The average Karnofsky Performance Status Scale score compared to the data before the procedure, one week after increased from 64.7 ± 7.9 to 78.2 ± 6.4 (P < 0.001). A significant improvement in functional status was maintained up to three months — 71.2 ± 6.9 (P < 0.001). However, in six months, this indicator was 63.5 ± 6.0 (Р = 0.668), which may be related not only to the intensity of the pain syndrome, but also to other complications of the underlying disease (ascites, cachexia, tumor growth, palliative surgical interventions, etc.). Conclusions. Computed tomography-guided celiac plexus neurolysis is a safe and effective procedure for patients with abdominal pain caused by inoperable pancreatic cancer. Sympatholysis provides a long-term significant reduction in pain syndrome according to the visual analogue scale after 1, 3, 6 months (Р < 0.001) and increases the functional status of patients according to the Karnofsky Performance Status Scale in 1 (Р < 0.001), 3 months (Р = 0.023). Celiac plexus neurolysis should be considered as part of a multidisciplinary approach to the comprehensive treatment of upper abdominal pain associated with cancer in the early stages of the disease.

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Section: рисунок 4 демонстрація двобічного заднього паравертебральног...unclassified

Minimally invasive interventions on celiac plexus in patients with persistent abdominal pain caused by pancreatic cancer

Eroshkin,

Romanukha

2024

INJ

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“…One rare and potentially devastating complication of celiac plexus blocks is anterior spinal artery syndrome, which can result in lower extremity paralysis [5]. There is no incidence rate reported for this rare complication, but there are case reports [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block

West,

Pogu,

Wanderman

et al. 2023

Cureus

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Celiac plexus blocks have been utilized to treat chronic abdominal pain of various etiologies that are refractory to medication management. This procedure is considered relatively safe; however, one rare complication is anterior spinal artery syndrome, which can result in temporary or permanent paralysis of the lower extremities. A 67-year-old male with a history of metastatic esophageal adenocarcinoma and chronic pain refractory to high doses of opioids presented for a celiac plexus neurolytic block. The block was performed successfully with a test block containing 2% lidocaine and 0.5% bupivacaine, after which neurolysis with alcohol was completed. The patient had a syncopal episode in the post-anesthesia care unit (PACU), which resolved with fluid resuscitation without requiring advanced cardiovascular life support (ACLS). He was then discharged. On the evening of discharge, the patient had progressive lower extremity weakness to the point where he was unable to walk even with significant assistance from a family member. He went to the emergency department where a complete spine MRI was done which did not show any spinal cord defect. His physical exam showed preserved proprioception and vibration sensation with upper motor neuron exam signs. The remainder of his sensory exam was inconsistent with both reported intact sensation to pinprick and temperature with intermittently reported hyperalgesia in his lower extremities. Over the next day of admission, his weakness slowly improved. Unfortunately, the patient developed a bowel perforation during hospitalization that was non-operable, and he passed away on hospital day five. This patient likely had anterior spinal artery vasospasm causing temporary lower extremity weakness. Given his overall debility, his physical exam was difficult, although he had intact proprioception and vibration sensation with upper motor neuron exam findings suggestive of an anterior cord process. Vasospasm could be secondary to needle placement near the artery of Adamkiewicz, alcohol, or epinephrine. This case emphasizes the importance of recognizing anterior spinal artery syndrome despite its rarity in patients undergoing celiac plexus neurolysis. Regardless of the rarity of various complications, it is imperative that physicians discuss potential devastating complications of procedures with patients to allow for individualized decision-making. Additionally, there should be a low threshold for overnight admission after celiac plexus neurolytic blocks in patients with severe underlying systemic disease processes.

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Sympathetic Blocks for Visceral Pain

Vorenkamp

Kemp

2022

Physical Medicine and Rehabilitation Clinics of North America

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Paraplegia after celiac plexus neurolysis in a patient with pancreatic cancer - A case report and literature review -

Cited by 3 publications

References 17 publications

Minimally invasive interventions on celiac plexus in patients with persistent abdominal pain caused by pancreatic cancer

Minimally invasive interventions on celiac plexus in patients with persistent abdominal pain caused by pancreatic cancer

Possible Transient Anterior Spinal Artery Syndrome After a Celiac Plexus Neurolytic Block

Sympathetic Blocks for Visceral Pain

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