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Kim SH, Jang KH, Cheon BK, Lim JA, Woo NS, Kim HK, Kim JH. Paraplegia after celiac plexus neurolysis in a patient with pancreatic cancer - A case report and literature review -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Sung Hoon Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Hwan Jang
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Bo Kyung Cheon
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Ae Lim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Nam Sik Woo
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Kyung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae-hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Köker IH, Aralaşmak A, Ünver N, Asil T, Şentürk H. Spinal cord ischemia after endoscopic ultrasound guided celiac plexus neurolysis: case report and review of the literature. Scand J Gastroenterol 2017. [PMID: 28625083 DOI: 10.1080/00365521.2017.1335771] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Endosonography guided celiac plexus neurolysis is efficacious in the management of severe pain due to advanced pancreatic cancer. Although endoscopic ultrasound (EUS) guided celiac neurolysis (CN) is mostly a safer procedure than the percutaneous posterior approach, severe complications such as paraplegia have been reported. CASE REPORT We describe a patient with advanced adenocarcinoma of the pancreas and severe pain who developed irreversible paraplegia after EUS guided CN. CONCLUSIONS Endosonography guided celiac plexus neurolysis also might be complicated with paraplegia as already observed with percutaneous approach. The underlying mechanism could not be explained clearly until now. We detected concomitant embolic occlusion of Adamkiewicz and anterior radicularis magna arteries in magnetic resonance angiography. So, this procedure must be considered only for malignancy patients.
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Affiliation(s)
- Ibrahim Hakkı Köker
- a Medicine Faculty, Gastroenterology Department , Bezmialem Vakıf University , Istanbul , Turkey
| | - Ayşe Aralaşmak
- b Medicine Faculty, Radiology Department , Bezmialem Vakıf University , Istanbul , Turkey
| | - Nurcan Ünver
- c Medicine Faculty, Pathology Department , Bezmialem Vakıf University , Istanbul , Turkey
| | - Talip Asil
- d Medicine Faculty, Neurology Department , Bezmialem Vakıf University , Istanbul , Turkey
| | - Hakan Şentürk
- a Medicine Faculty, Gastroenterology Department , Bezmialem Vakıf University , Istanbul , Turkey
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Smith H, Youn Y, Guay RC, Laufer A, Pilitsis JG. The Role of Invasive Pain Management Modalities in the Treatment of Chronic Pain. Med Clin North Am 2016; 100:103-15. [PMID: 26614722 DOI: 10.1016/j.mcna.2015.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Invasive analgesic therapies provide an alternative to medical management of chronic pain. With the increasing incidence of chronic pain not only in the United States but worldwide, more therapies have evolved to address the growing need for pain relief options. These therapies include spinal injections, nerve blocks, radiofrequency ablation, neurostimulation, and intrathecal drug delivery.
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Affiliation(s)
- Heather Smith
- Department of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Youngwon Youn
- Department of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Ryan C Guay
- Department of Anesthesiology, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Andras Laufer
- Department of Anesthesiology, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA.
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Abstract
BACKGROUND Pain originating from the organs of the upper abdomen, especially in patients suffering from inoperable carcinoma of the pancreas or advanced inflammatory conditions, is difficult to treat in a significant number of patients. STANDARD RADIOLOGICAL PROCEDURES Computed tomography (CT) guided neurolysis is the most commonly used technique for neurolysis of the celiac plexus. Ethanol is used to destroy the nociceptive fibers passing through the plexus and provides an effective means of diminishing pain arising from the upper abdomen. METHODS Using either an anterior or posterior approach, a 22 G Chiba needle is advanced to the antecrural space and neurolysis is achieved by injecting a volume of 20-50 ml of ethanol together with a local anesthetic and contrast medium. PERFORMANCE In up to 80% of patients suffering from tumors of the upper abdomen, CT-guided celiac plexus neurolysis diminishes pain or allows a reduction of analgesic medication; however, in some patients the effect may only be temporary necessitating a second intervention. In inflammatory conditions, celiac neurolysis is often less effective in reducing abdominal pain. PRACTICAL RECOMMENDATIONS The CT-guided procedure for neurolysis of the celiac plexus is safe and effective in diminishing pain especially in patients suffering from tumors of the upper abdomen. The procedure can be repeated if the effect is only temporary.
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Nagels W, Pease N, Bekkering G, Cools F, Dobbels P. Celiac plexus neurolysis for abdominal cancer pain: a systematic review. PAIN MEDICINE 2013; 14:1140-63. [PMID: 23802777 DOI: 10.1111/pme.12176] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This systematic review assesses the effectiveness and side effects of celiac plexus neurolysis (CPN) in the treatment of upper abdominal cancer pain, and evaluates whether there are any differences between the percutaneous and endoscopic ultrasound-guided (EUS) denervation techniques. METHODS Five databases were searched, expanded by assessing the reference lists of all retrieved papers. Sixty-six publications fulfilled the inclusion/exclusion criteria and were included in the systematic review. Randomized controlled trials were available for the percutaneous CPN, and therefore meta-analyses were performed for pain, opioid consumption, and specific side effects. The quality of life data were too heterogeneous to be assessed by a meta-analysis, and evidence for EUS CPN could only be evaluated by observational studies. RESULTS Meta-analyses show that percutaneous CPN significantly improves pain in patients with upper abdominal cancer, with a decrease in opioid consumption and side effects. It is unclear whether there is any change in quality of life. Case series suggest that EUS CPN improves pain. No conclusion can be made about EUS CPN's influence on opioid consumption. Although CPN is a safe procedure, side effects and complications can occur with both the percutaneous and EUS techniques. CONCLUSIONS Following this review, evidence suggests that CPN should be considered in patients with upper abdominal cancer where the pain is not adequately controlled with systemic analgesics or when significant opioid-induced side effects are present. The percutaneous approach remains the standard technique as robust evidence for EUS CPN is lacking.
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Affiliation(s)
- Werner Nagels
- Department of Anesthesiology and Pain Management, Heilig-Hart Hospital Roeselare-Menen, Roeselare, Belgium.
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Abstract
Cancer pain is prevalent and often multifactorial. For a segment of the cancer pain population, pain control remains inadequate despite full compliance with the WHO analgesic guidelines including use of co-analgesics. The failure to obtain acceptable pain or symptom relief prompted the inclusion of a fourth step to the WHO analgesic ladder, which includes advanced interventional approaches. Interventional pain-relieving therapies can be indispensable allies in the quest for pain reduction among cancer patients suffering from refractory pain. There are a variety of techniques used by interventional pain physicians, which may be grossly divided into modalities affecting the spinal canal (e.g., intrathecal or epidural space), called neuraxial techniques and those that target individual nerves or nerve bundles, termed neurolytic techniques. An array of intrathecal medications are infused into the cerebrospinal fluid in an attempt to relieve refractory cancer pain, reduce disabling adverse effects of systemic analgesics, and promote a higher quality of life. These intrathecal medications include opioids, local anesthetics, clonidine, and ziconotide. Intrathecal and epidural infusions can serve as useful methods of delivering analgesics quickly and safely. Spinal delivery of drugs for the treatment of chronic pain by means of an implantable drug delivery system (IDDS) began in the 1980s. Both intrathecal and epidural neurolysis can be effective in managing intractable cancer-related pain. There are several sites for neurolytic blockade of the sympathetic nervous system for the treatment of cancer pain. The more common sites include the celiac plexus, superior hypogastric plexus, and ganglion impar. Today, interventional pain-relieving approaches should be considered a critical component of a multifaceted therapeutic program of cancer pain relief.
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Affiliation(s)
- Paul J Christo
- Department of Anesthesiology & Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Alshab AK, Goldner JD, Panchal SJ. Complications of sympathetic blocks for visceral pain. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.trap.2007.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg 2005; 75:640-4. [PMID: 16076323 DOI: 10.1111/j.1445-2197.2005.03486.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Splanchnic nerve block is a useful alternative to coeliac plexus block in the management of patients with chronic upper abdominal pain. The predictable relationship of the splanchnic nerves to other structures allows for accurate needle placement and hence a low risk of iatrogenic damage. Radiofrequency ablation (RFA) uses a high frequency alternating current to heat tissues leading to thermal coagulation. It produces predictable and accurate lesions and hence is useful alternative to more conventional phenol and alcohol neurolytic methods. METHODS The present study examined a series of 10 patients undergoing percutaneous RFA splanchnic nerve blockade for chronic pancreatitis. Pain levels, anxiety, quality of life, daily activity, mood and interpersonal relationships were all assessed pre- and postprocedure, using a visual analogue score. Median follow-up was 18 months (range: 12-24 months). Statistical analysis was undertaken using non-parametric Wilcoxon matched pair analysis, statistical significance was set at the 95% confidence intervals. RESULTS Splanchnic nerve RFA not only led to a decrease in pain scores, opiate analgesia use and acute admissions for pain; but it also resulted in improvement of other parameters associated with long-term debilitating chronic pain, such as anxiety levels, daily activity, overall mood and general perception of health. There were no major complications. All changes observed were statistically significant. CONCLUSION Although preliminary data regarding RFA ablation of splanchnic nerves are encouraging, further trials are also needed comparing percutaneous splanchnic nerve ablation with opioid analgesia and coeliac plexus blockade.
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Affiliation(s)
- Giuseppe Garcea
- Department of Hepatobiliary and Pancreatic Surgery, The Leicester General Hospital, Leicester, United Kingdom.
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de Leon-Casasola OA. Interventional Procedures for Cancer Pain Management: When Are They Indicated? Cancer Invest 2004; 22:630-42. [PMID: 15565820 DOI: 10.1081/cnv-200027166] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Non-invasive pharmacological management of patients with cancer related pain has resulted in pain control in 90-95% of the patients. Thus, 5-10% of patients still experience inadequate pain control despite aggressive combined pharmacological therapy. Moreover, patients may not tolerate an aggressive program of titration of medications and fail this approach because of side effects. In these patients interventional techniques have been very useful. This article discusses the alternative therapies, as well as the pitfalls in implementing these therapies, to achieve the highest possible success while minimizing potential complications and side effects.
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Kitzmann KM, Gaylord NK, Holt AR, Kenny ED. Child witnesses to domestic violence: a meta-analytic review. J Consult Clin Psychol 2003; 71:339-52. [PMID: 12699028 DOI: 10.1037/0022-006x.71.2.339] [Citation(s) in RCA: 590] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This meta-analysis examined 118 studies of the psychosocial outcomes of children exposed to interparental violence. Correlational studies showed a significant association between exposure and child problems (d = -0.29). Group comparison studies showed that witnesses had significantly worse outcomes relative to nonwitnesses (d = -0.40) and children from verbally aggressive homes (d = -0.28). but witnesses' outcomes were not significantly different from those of physically abused children (d = 0.15) or physically abused witnesses (d = 0.13). Several methodological variables moderated these results. Similar effects were found across a range of outcomes, with slight evidence for greater risk among preschoolers. Recommendations for future research are made, taking into account practical and theoretical issues in this area.
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Kim HJ, Seo K, Yum KW, Oh YS, Yoon TG, Yoon SM. Effects of botulinum toxin type A on the superior cervical ganglia in rabbits. Auton Neurosci 2002; 102:8-12. [PMID: 12492130 DOI: 10.1016/s1566-0702(02)00093-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sympathetic neurolysis is very important in treating chronic pain, especially sympathetically maintained pain. However, conventional neurolytic agents destroy nerve fibers nonselectively and may leave serious complications. Botulinum toxin type A (BTA) selectively acts on cholinergic nerves and inhibits the secretion of acetylcholines (Ach) at the involved nerve endings. Because cholinergic nerves also exist in autonomic ganglia, it is believed that BTA has pharmacological effects on sympathetic ganglia. In this study, after the administration of BTA into the superior cervical ganglion (SCG) in rabbits, the possible clinical use of BTA as a neurolytic agent was evaluated. In the normal saline-treated control group, miosis was not observed in all 12 rabbits. However, in the BTA-treated group, 15 cases of miosis were observed among 40 rabbits (37.5%). Furthermore, BTA induced miosis in a dose-dependent manner, though onset time and duration of miosis varied. Mean time of onset and duration were 1.8 days and 5.3 weeks, respectively. By eosin-hematoxylin (H&E) staining finding, no significant chronological and histological changes between the control and the experimental groups were observed. In conclusion, BTA was found to have a sympathetic ganglion blocking effect over a period of more than 1 month without causing considerable pathologic changes in the SCG, that is, this toxin may be used in the case of sympathetically maintained pain control as a sympatholytic.
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Affiliation(s)
- Hyun Jeong Kim
- Department of Dental Anesthesiology, Dental Research Institute, College of Dentistry, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea.
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Soria MT, Solé M, Pellisé M, Bordas JM, Ginès A. [Interventional diagnostic and therapeutic endoscopic ultrasonography]. GASTROENTEROLOGIA Y HEPATOLOGIA 2002; 25:467-74. [PMID: 12139843 DOI: 10.1016/s0210-5705(02)70290-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M T Soria
- Unidad de Endoscopia Digestiva, Institut de Malalties Digestives, Hospital Clínic, Barcelona, Spain
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Ginès A, Vázquez-Sequeiros E, Wiersema M. Ultrasonografía endoscópica intervencionista diagnóstica y terapéutica. GASTROENTEROLOGIA Y HEPATOLOGIA 2002. [DOI: 10.1016/s0210-5705(02)70240-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Ischia S, Polati E, Finco G, Gottin L. Celiac block for the treatment of pancreatic pain. CURRENT REVIEW OF PAIN 2001; 4:127-33. [PMID: 10998724 DOI: 10.1007/s11916-000-0046-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Neurolytic celiac plexus block (NCPB) is commonly performed to relieve pancreatic cancer pain. Since Kappis described the percutaneous NCPB, a number of variations of this technique have been proposed to improve analgesic results and minimize complications. In this article, we review and discuss techniques, results, and complications of NCPB.
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Affiliation(s)
- S Ischia
- Department of Anesthesiology and Intensive Care, Pain Relief Center, Hospital Policlinico, Verona 37134, Italy.
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Neurolytic Blocks of the Sympathetic Axis for the Treatment of Visceral Pain in Cancer. CURRENT REVIEW OF PAIN 2000; 3:173-177. [PMID: 10998671 DOI: 10.1007/s11916-999-0010-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pain due to cancer is frequently visceral, and neurolysis of the sympathetic axis has been shown to be an effective and safe method for treating this visceral pain. Several studies have documented the efficacy of neurolytic blocks both by a reduction in the intensity of pain and by a decrease in opioid consumption. Neurolysis of the sympathetic axis should be incorporated into the pain specialist's arsenal as an adjuvant to oral pharmacologic therapy.
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de Leon-Casasola OA. Critical evaluation of chemical neurolysis of the sympathetic axis for cancer pain. Cancer Control 2000; 7:142-8. [PMID: 10783818 DOI: 10.1177/107327480000700204] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with pain caused by cancer frequently experience visceral pain. In addition to oral pharmacologic therapy to manage pain, neurolytic blocks of the sympathetic axis are also effective in controlling visceral cancer pain. METHODS Four types of neurolytic blocks (interpleural phenol, celiac plexus, superior hypogastric plexus, and ganglion impar) used in the treatment of visceral cancer pain are reviewed. RESULTS Several studies have documented the efficacy of neurolytic blocks in reducing pain intensity and opioid consumption. However, the narrow risk-benefit ratio associated with neurolysis techniques requires knowledge of the implications associated with the different neurolytic blocks to minimize undesirable effects. CONCLUSIONS Neurolysis of the sympathetic axis has been shown to be an effective and safe approach to treat visceral pain in cancer patients and should be incorporated in the armamentarium of the pain specialist as a useful adjunct to oral pharmacologic therapy.
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Abstract
The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.
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Affiliation(s)
- E K Abdalla
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610-0286, USA
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Abstract
Coeliac plexus blocks have been used successfully in the treatment of abdominal pain in advanced cancer and in benign chronic abdominal pain. However, concern remains about occasional potentially serious complications. One possible way to reduce the risks of this procedure may be to improve imaging during the procedure. We report a series of 38 coeliac plexus blocks carried out under computer tomographic (CT) guidance, mostly using the anterior approach. The technique is described. Effectiveness and side-effect rates were similar to other reported series. There were no major complications. Analysis of contrast spread would indicate that anterior preaortic or bilateral contrast spread is necessary to obtain pain relief. Our experience would indicate that routine CT guidance can be a simple aid to coeliac plexus block, and can be achieved easily in a district general hospital. Improved imaging allows accurate needle placement, while avoiding vital structures such as the aorta and pleura. Accurate placement may also allow the use of reduced volumes of neurolytic drugs.
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Affiliation(s)
- A Perello
- King Edward VII Hospital, Midhurst, UK
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Affiliation(s)
- J Hayakawa
- Department of Anesthesia, Kanagawa Cancer Center Hospital, Yokohama, Japan
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Naveira FA, Speight KL, Rauck RL. Atheromatous aortic plaque as a cause of resistance to needle passage during transaortic celiac plexus block. Anesth Analg 1996; 83:1327-9. [PMID: 8942608 DOI: 10.1097/00000539-199612000-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F A Naveira
- Department of Anesthesia (Pain Control Center), Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1009, USA
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Naveira FA, Speight KL, Rauck RL. Atheromatous Aortic Plaque as a Cause of Resistance to Needle Passage During Transaortic Celiac Plexus Block. Anesth Analg 1996. [DOI: 10.1213/00000539-199612000-00034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Pancreatic cancer has a very poor prognosis and is often associated with severe pain. A variety of pain syndromes and pain pathophysiologies can be identified. Information about the analgesic efficacy of available oncological treatments is very limited, but the available data suggest that pharmacological and non-pharmacological approaches can be effective in the majority of cases. Guidelines have been developed for drug administration that emphasize indications, selection of routes, optimal dosing, and side effect treatment. Celiac plexus block can be considered for a subgroup of patients who fail to benefit from drug therapy. Optimally, pain management should be provided within a broader model of palliative care, which can address the many problems associated with this challenging disease.
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Affiliation(s)
- A Caraceni
- Pain Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, USA
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Kawamata M, Ishitani K, Ishikawa K, Sasaki H, Ota K, Omote K, Namiki A. Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain. Pain 1996; 64:597-602. [PMID: 8783327 DOI: 10.1016/0304-3959(95)00189-1] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block (CPB) on pain relief and quality of life (QOL), compared to the traditional NSAID-morphine treatment. The criteria were morphine consumption, visual analogue pain scale (VAS), performance status (PS) determined by medical and nursing staffs, and answers to QOL questionnaires. Morphine consumption, VAS, PS, and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control. Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter. CPB was performed within 2-3 days after the control measurement. The VAS scores of the patients receiving CPB (n = 10) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the standard NSAID-morphine treatment (n = 11) during the same time period after the control measurement. Morphine consumption was significantly lower in weeks 4-7 (inclusive) following the procedure in the CPB group and continued to be lower thereafter, though not significantly so. Although the PS score slightly improved at the 2nd week after CPB, it was not improved by the start of the NSAID-morphine treatment. Self-assessed QOL scores did not ameliorate statistically after CPB; however, they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods, while they deteriorated only slightly in the CPB group. There were fewer side effects after CPB. These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain, but it may prevent deterioration in QOL by the long-lasting analgesic effect, limitation of side effects and the reduction of morphine consumption, compared to treatment only with NSAID-morphine.
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Affiliation(s)
- Mikito Kawamata
- Department of Anesthesia, Higashi Sapporo Hospital, 3-3-17, Higashi-Sapporo, Shiroishi-ku, Sapporo 003 Japan Department of Internal Medicine, Higashi Sapporo Hospital, 3-3-17, Higashi-Sapporo, Shiroishi-ku, Sapporo 003 Japan Institute of Palliative Care Medicine, Higashi Sapporo Hospital, 3-3-17, Higashi-Sapporo, Shiroishi-ku, Sapporo 003 Japan Department of Anesthesiology, Sapporo Medical University, School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060 Japan
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Reply to the letter by Dr R.B. Traycoff et al. Pain 1995. [DOI: 10.1016/0304-3959(95)90036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Traycoff RB, Khardori R, Zhong W. Comments on DeConno (Pain, 55 (1993) 383-385) and Brown (Pain, 56 (1994) 139-143). Pain 1995; 60:233-234. [PMID: 7784111 DOI: 10.1016/0304-3959(94)00200-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Roger B Traycoff
- Pain Management Service Division of Rheumatology & Algology Department of Medicine Southern Illinois University School of Medicine P.O. Box 19230 Springfield, IL 62794, USA
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30
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Reply to Traycoff et al. ‘Letter-to-the-Editor’ and comments on DeConno and Brown. Pain 1995. [DOI: 10.1016/0304-3959(95)90037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Van Dongen RT, Crul BJ. Comments on Y. Fujita. Pain 1994. [DOI: 10.1016/0304-3959(94)90232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brown DL, Rorie DK. Altered reactivity of isolated segmental lumbar arteries of dogs following exposure to ethanol and phenol. Pain 1994; 56:139-143. [PMID: 8008403 DOI: 10.1016/0304-3959(94)90087-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Celiac plexus neurolysis is a useful analgesic technique in patients with upper abdominal cancer. Although complications are infrequent, occasionally celiac neurolysis results in paraplegia. It is hypothesized that paraplegia after celiac neurolysis results from neurolytic drug-induced spasm of lumbar segmental arteries that perfuse the spinal cord, although no data are available to support or refute the idea. Whether drugs used for celiac plexus neurolysis alter the reactivity of dogs' lumbar segmental arteries was studied in vitro. Rings of lumbar segmental arteries, suspended in Krebs-Ringer solution in organ baths, were passively stretched to the optimal point on their length-tension curve. After a 45-min rest the responsiveness of each ring was established by adding an ED50 concentration of norepinephrine to the bath. Subsequently, Krebs-Ringer solution containing a single concentration of phenol or ethanol was added. Concentrations studied included 1%, 3%, 6%, 7%, 8%, 9%, and 12% phenol; and 3%, 6%, 10%, 25%, 50%, 75%, and 90% ethanol. The magnitude of the phenol-induced contractile response was directly related to concentration, with 8%, 9% and 12% phenol, producing sustained contractile responses compared to norepinephrine-induced control contractile responses. The ethanol-induced contractile response was inversely related to concentration. Ethanol (3% and 6%) produced sustained contractile responses compared to norepinephrine-induced control contractile responses. Studies were then done to further elucidate the agonist properties of phenol and ethanol. The contractions caused by ethanol or phenol did not appear to be mediated through adrenergic, opioid, muscarinic, or serotonin receptors or sodium channels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- David L Brown
- Department of Anesthesiology, Mayo Clinic and Foundation, Rochester, MN 55905 USA
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34
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De Conno F, Caraceni A, Aldrighetti L, Magnani G, Ferla G, Comi G, Ventafridda V. Paraplegia following coeliac plexus block. Pain 1993; 55:383-385. [PMID: 8121700 DOI: 10.1016/0304-3959(93)90015-h] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coeliac plexus block (CPB) is one of the few neurolytic procedures that is still considered very useful in managing chronic cancer pain. We describe what we believe to be the fifth case in the literature of paraplegia following coeliac plexus block with ethyl alcohol. Clinical and neurophysiological examination confirmed the hypothesis of an acute myelopathy probably caused by ischemia due to involvement of Adamkievicz's artery. The seriousness of this neurological complication led us to review the different pain-relieving strategies in pancreatic cancer. Several medical and surgical procedures are available for advanced pancreatic cancer, yet none of them alone can be considered the therapy of choice for all cases. Hence, only a multidisciplinary approach to pancreatic cancer pain can help in making the most appropriate choice for each patient.
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Affiliation(s)
- Franco De Conno
- Pain Therapy and Palliative Care Division National Cancer Institute, MilanItaly Departments of Clinical Surgery, University of Milan, Scientific Institute, San Raffaele Hospital, MilanItaly Departments of Clinical Neurology IV, University of Milan, Scientific Institute, San Raffaele Hospital, MilanItaly
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35
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Abstract
The purpose of this article is to familiarize the anaesthetist with the basic anatomy of the coeliac plexus; the techniques used to perform the procedure, its indications, complications and results in the management of chronic abdominal pain syndromes. Radiological, surgical and anaesthetic literature from the beginning of the century were reviewed. The main indication for neurolytic coeliac plexus block is intractable pain secondary to carcinoma of the pancreas or stomach. There appear to be theoretical advantages to techniques that result in spread of solution anterior to the aorta, such as the trans-aortic approach. These have not yet been demonstrated in any studies with large numbers of patients.
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Affiliation(s)
- F Fugère
- Department of Anaesthesia, Ottawa Civic Hospital, Ottawa University, Ontario
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36
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Abstract
The number of neurolytic coeliac plexus blocks carried out in England and Wales over a 5 year period (1986–1990) was ascertained. The number of cases of the major complications of permanent paraplegia and/or loss of anal and bladder sphincter function following on from such blocks, over the same period of time, was also ascertained. The information was obtained by means of a questionnaire which was sent to most of the pain clinics in England and Wales. There were 2730 neurolytic blocks carried out over the 5 year period. The number of cases of permanent paraplegia following on from the blocks was four. Of these four cases, three of them also had loss of anal and bladder sphincter function — loss of sphincter function never occurred in isolation. The incidence of major complications following neurolytic coeliac plexus block was thus one case per 683 blocks.
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Affiliation(s)
- D D Davies
- Department of Anaesthesia, Central Middlesex Hospital, London
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37
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Abstract
Permanent paraplegia following coeliac plexus block has been reported on several occasions. We report a case of reversible paraplegia following coeliac plexus block.
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38
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Abstract
A case is described in which a coeliac plexus block with alcohol 48%, performed under X ray control, resulted in paraplegia. Ischaemia of the spinal cord, due to damage to the arterial blood supply, was thought to be the cause.
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Affiliation(s)
- R T van Dongen
- Institute for Anesthesiology, University Hospital, Nijmegen, The Netherlands
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