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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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Oguz G, Senel G, Kocak N. Transient paraplegia after neurolytic splanchnic block in a patient with metastatic colon carcinoma. Korean J Pain 2018; 31:50-53. [PMID: 29372026 PMCID: PMC5780216 DOI: 10.3344/kjp.2018.31.1.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/05/2022] Open
Abstract
We present a patient with metastatic colon carcinoma who developed paraplegia following a neurolytic splanchnic block. A 41-year old man with metastatic adenocarcinoma of the colon received a splanchnic neurolytic block using alcohol because of severe abdominal pain. Bilateral motor weakness and a sensorial deficit in both legs developed after the procedure. Diffusion magnetic resonance imaging revealed spinal cord ischemia between T8 and L1. The motor and sensorial deficits were almost completely resolved at the end of the third month. We think that anterior spinal artery syndrome due to reversible spasms of the lumbar radicular arteries using alcohol have resulted in transient paraplegia. The retrograde spread of alcohol to neural structures may have also contributed.
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Affiliation(s)
- Gonca Oguz
- Department of Anesthesiology, Pain and Palliative Care Clinic, Dr AY Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Gulcin Senel
- Department of Anesthesiology, Pain and Palliative Care Clinic, Dr AY Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Nesteren Kocak
- Department of Anesthesiology, Pain and Palliative Care Clinic, Dr AY Ankara Oncology Education and Research Hospital, Ankara, Turkey
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Chantarojanasiri T, Aswakul P, Prachayakul V. Uncommon complications of therapeutic endoscopic ultrasonography: What, why, and how to prevent. World J Gastrointest Endosc 2015; 7:960-968. [PMID: 26265989 PMCID: PMC4530329 DOI: 10.4253/wjge.v7.i10.960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023] Open
Abstract
There is an increasing role for endoscopic ultrasound (EUS)-guided interventions in the treatment of many conditions. Although it has been shown that these types of interventions are effective and safe, they continue to be considered only as alternative treatments in some situations. This is in part due to the occurrence of complications with these techniques, which can occur even when performed by experienced endosonographers. Although common complications have been described for many procedures, it is also crucial to be aware of uncommon complications. This review describes rare complications that have been reported with several EUS-guided interventions. EUS-guided biliary drainage is accepted as an alternative treatment for malignant biliary obstruction. Most of the uncommon complications related to this procedure involve stent malfunction, such as the migration or malposition of stents. Rare complications of EUS-guided pancreatic pseudocyst drainage can result from air embolism and infection. Finally, a range of uncommon complications has been reported for EUS-guided celiac plexus neurolysis, involving neural and vascular injuries that can be fatal. The goal of this review is to identify possible complications and promote an understanding of how they occur in order to increase general awareness of these adverse events with the hope that they can be avoided in the future.
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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: 86] [Impact Index Per Article: 7.8] [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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5
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Levy MJ, Chari ST, Wiersema MJ. Endoscopic ultrasound-guided celiac neurolysis. Gastrointest Endosc Clin N Am 2012; 22:231-47, viii. [PMID: 22632946 DOI: 10.1016/j.giec.2012.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intractable abdominal pain commonly develops in patients with pancreatic cancer. Oral pharmacologic therapy is ineffective for many patients and side effects commonly occur. Celiac neurolysis (CN) is sometimes performed to enhance pain relief. Percutaneous approaches were initially described, with endoscopic ultrasound (EUS)-guided CN more recently introduced. There is uncertainty regarding the efficacy and role of CN in managing pancreatic cancer pain, but CN should still be considered in this difficult-to-treat cohort of patients. EUS-guided approaches may be favored when EUS is otherwise indicated for diagnostic or staging purposes. When EUS is not otherwise indicated, percutaneous approaches are likely favored.
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Vissers KCP, Besse K, Wagemans M, Zuurmond W, Giezeman MJMM, Lataster A, Mekhail N, Burton AW, van Kleef M, Huygen F. 23. Pain in Patients with Cancer. Pain Pract 2011; 11:453-75. [PMID: 21679293 DOI: 10.1111/j.1533-2500.2011.00473.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kris C P Vissers
- Department of Anesthesiology Pain Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Soweid AM, Azar C. Endoscopic ultrasound-guided celiac plexus neurolysis. World J Gastrointest Endosc 2010; 2:228-31. [PMID: 21160938 PMCID: PMC2999129 DOI: 10.4253/wjge.v2.i6.228] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/25/2010] [Accepted: 06/01/2010] [Indexed: 02/05/2023] Open
Abstract
Endoscopic celiac plexus neurolysis (CPN) has become the procedure of choice for the management of patients with pancreatic cancer and abdominal pain unresponsive to medical treatment. It is necessary to differentiate between CPN and endoscopic celiac plexus block performed in patients with benign disease. In this review we describe the technique of this procedure with special emphasis on technical details.
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Affiliation(s)
- Assaad M Soweid
- Assaad M Soweid, Cecilio Azar, The American University of Beirut, Medical Center, Endoscopy-Bronchoscopy Unit, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Hamra 1103 2090, Beirut, Lebanon
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Abstract
Endoscopic ultrasound (EUS) has become well established as a diagnostic modality in gastrointestinal cancer staging. It offers high-resolution imaging and fine-needle biopsy, which is essential in tumor and nodal staging of gastrointestinal cancers. In the recent decade, however, many therapeutic applications of EUS have become possible. Currently, interventional EUS endoscopy involves celiac plexus neurolysis, pseudocyst drainage, and intratumoral fine-needle injection therapy for inoperable pancreatic malignancy. Emerging techniques include the accurate endoscopic delivery of radioactive beads to localize tumor therapy as well as other therapies, such as radiofrequency ablation or cryotherapy. Diagnostic and therapeutic access to the biliary tree and pancreatic duct is increasingly being used successfully in failed endoscopic retrograde cholangiopancreatography (ERCP) procedures. This review discusses these procedures and several evolving future applications, including vascular access and EUS-guided enteral anastomosis.
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9
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Abstract
This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
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Affiliation(s)
- John D Markman
- Neuromedicine Pain Management Center, Department of Neurosurgery and Neurology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 670 Rochester, New York 14642, USA.
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10
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Abstract
This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
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Affiliation(s)
- John D Markman
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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11
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Levy MJ, Wiersema MJ. Endoscopic ultrasound-guided pain control for intra-abdominal cancer. Gastroenterol Clin North Am 2006; 35:153-65, x. [PMID: 16530118 DOI: 10.1016/j.gtc.2005.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This article summarizes percutaneous and surgical methods for performing celiac plexus neurolysis and focuses on the technical aspects of endoscopic ultrasound-guided celiac plexus neurolysis. Published literature concerning endoscopic ultrasound-guided celiac plexus neurolysis is reviewed, indications are proposed, and opinions are offered concerning potential future applications and investigational needs as they apply to this technique.
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Affiliation(s)
- Michael J Levy
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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12
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Abstract
With the development of linear array echoendoscopes and the ability to perform endoscopic ultrasound (EUS)-guided fine-needle aspiration, the delivery of therapeutic agents with fine-needle injection (FNI) emerged. EUS-guided FNI is an attractive delivery system because of its minimal invasiveness and low complication rate. This approach is effective in performing celiac plexus neurolysis for pain relief in patients with pancreatic cancer. The most exciting area of interest involves the delivery of antitumor agents in patients with locally advanced cancer, such as cancer of the pancreas or esophagus. The involvement of EUS-guided FNI in tumor therapy adds a host of potential new applications that continue to swing the pendulum of EUS from a diagnostic to a therapeutic modality.
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Affiliation(s)
- Jason B Klapman
- Division of Gastroenterology, University of California Irvine Medical Center, 101 The City Drive, Building 22C, Route 99, Orange, California 92868, USA
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13
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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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Bhutani MS, Pasricha PJ. Neurolytic Approaches for the Treatment of Pain in Patients with Chronic Pancreatitis. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2003; 6:375-379. [PMID: 12954144 DOI: 10.1007/s11938-003-0040-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In large part, treatment options for patients with painful chronic pancreatitis remain empirical because of our limited understanding of the pathobiology of pancreatic pain. The procedures of neural block/ablation exemplify these limitations, which include the lack of a clear biologic rationale for various approaches, as well as unequivocal data on long-term outcomes and efficacy. Although the techniques themselves appear to be well established, controlled trials of various medical, endoscopic, radiologic, and surgical options to define the best treatment are clearly needed. In addition, the lack of uniform improvement with any technique underscores the need for applying a multidisciplinary approach to these patients, as should be the case for any chronic pain disorder.
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Affiliation(s)
- Manoop S. Bhutani
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, 4.106 McCullough Building, 301 University Boulevard, Galveston, TX 77555-0764, USA.
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Affiliation(s)
- Michael J Levy
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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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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Affiliation(s)
- Michael F Byrne
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
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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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20
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Gunaratnam NT, Wong GY, Wiersema MJ. EUS-guided celiac plexus block for the management of pancreatic pain. Gastrointest Endosc 2000; 52:S28-34. [PMID: 11115945 DOI: 10.1067/mge.2000.110718] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- N T Gunaratnam
- Division of Gastroenterology and Hepatology, St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
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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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25
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Neurolyse du plexus coeliaque guidée sous échoendoscopie Efficacité dans la pancréatite chronique et la pathologie maligne. ACTA ACUST UNITED AC 1998. [DOI: 10.1007/bf03016235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brown DL, Caswell RE, Wong GY, Nauss LA, Offord KP. Referral of patients with pain from pancreatic cancer for neurolytic celiac plexus block. Mayo Clin Proc 1997; 72:831-4. [PMID: 9294530 DOI: 10.4065/72.9.831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess whether patients with pancreatic cancer-associated pain living near a pain control center were more likely to undergo neurolytic celiac plexus block (NCPB) than those living at a distance and to determine the rationale of physicians at our institution for referring patients for NCPB. DESIGN We retrospectively reviewed the frequency of use of NCPB in patients with pancreatic cancer and conducted an anonymous physician survey of referral patterns for NCPB for such patients. MATERIAL AND METHODS A prospective database of medical diagnoses and a clinical database at our institution were used to identify patients with pancreatic cancer within three geographic regions who were assessed during the inclusive years 1980 through 1989: group I ("local") = all patient with pancreatic cancer in Olmsted County, Minnesota; group II ("surrounding") and group III ("distant") = patients referred for pancreatic cancer evaluation who lived within 100 miles of our institution (excluding Olmsted County) or more than 100 miles from our institution, respectively. Medical records were retrospectively reviewed to assess the use of NCPB at any time during the course of pancreatic cancer. For the physician survey component, all medical oncologists, gastroenterologists, and general surgeons at our institution who might be responsible for the care of patients with pancreatic cancer were sent a questionnaire about their referral patterns for NCPB among patients with pancreatic cancer. RESULTS Overall, approximately 15% of the 292 patients with pancreatic cancer studied underwent NCPB. Distance from our pain control center was not found to be associated with frequency of use of NCPB. Of the 78 physicians surveyed, 59 (76%) responded, and 35 of the responders (59%) had encountered at least 1 patient with pancreatic cancer during the preceding 12 months. In that subset of physicians, perceived barriers for referral for NCPB were limited appointment availability and need for repeating the procedure. CONCLUSION On the basis of this study, referral patterns for NCPB in patients with pancreatic cancer do not seem to be associated with the geographic distance of a patient's residence from a pain control center. Improving appointment availability for NCPB might increase the number of patients offered this technique for control of pain.
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Affiliation(s)
- D L Brown
- Department of Anesthesiology, Mayo Clinic Rochester, MN 55905, 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; 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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28
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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
BACKGROUND We have evaluated the safety and efficacy of performing endosonography-guided celiac plexus neurolysis (EUS CPN) in patients with pain due to intra-abdominal malignancies. METHODS Thirty patients with upper abdominal pain requiring narcotic analgesia and suspected or known intra-abdominal malignancy were selected for EUS CPN. This group included 25 patients with pancreas carcinoma and 5 patients with intra-abdominal metastases. Using the linear array ultrasound endoscope and a prototype needle catheter, transgastric injection of the celiac plexus with bupivacaine and 98% dehydrated absolute alcohol was accomplished. RESULTS Pain scores were significantly lower compared with baseline at 2, 4, 8, and 12 weeks after EUS CPN (median follow-up: 10 weeks). At these follow-up intervals, 82% to 91% of patients required the same or less pain medication and 79% to 88% of patients had persistent improvement in their pain score. Comparison of patients with TXNXM1 versus TXNXMO pancreatic carcinoma revealed higher initial pain scores (7.9 +/- 1.92 versus 5.8 +/- 2.0, p = .02) and a greater decline in pain scores (decrease of 6.1 +/- 3.1 versus 4.8 +/- 2.0, p = .004). Complications were minor and consisted of transient diarrhea in four patients. CONCLUSION EUS CPN is a safe and effective means for improving pain control in patients with intra-abdominal malignancy. The technique may be performed as an outpatient at the same setting as the EUS staging examination.
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Affiliation(s)
- M J Wiersema
- Department of Medicine, St. Vincent Hospitals, Indianapolis, Indiana, USA
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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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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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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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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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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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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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