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Lu F, Wang X, Tian J, Li X. Early versus delayed computed tomography-guided celiac plexus neurolysis for palliative pain management in patients with advanced pancreatic cancer: a retrospective cohort study. Front Neurol 2023; 14:1292758. [PMID: 38020651 PMCID: PMC10661893 DOI: 10.3389/fneur.2023.1292758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Abdominal and back pain is the most frequent symptom in patients with pancreatic cancer, with pain management being extremely challenging. This study aimed to evaluate pain control, opioid consumption, pain-interfered quality of life, and survival after early and delayed computed tomography (CT)-guided celiac plexus neurolysis (CPN). Methods A retrospective analysis of pancreatic cancer patients receiving CPN for pain (n = 56) between June 2018 and June 2021 was done. The patients were grouped as early group (n = 22) and delayed group (n = 34) on the basis of the presence of persistent refractory pain according to expert consensus on refractory cancer pain. Results Both groups were comparable in demographic characteristics and baseline pain conditions measured using the numeric rating scale (5.77 ± 1.23 vs. 6.27 ± 1.21; p = 0.141). The pain scores were significantly reduced in both groups; early CPN resulted in significantly lower scores from 3 to 5 months. The opioid consumption gradually decreased to a minimum at 2 weeks but increased at 1 month (35.56 ± 30.14 mg and 50.48 ± 47.90 mg, respectively); significantly larger consumption from 2 to 4 months was seen in the delayed group. The total pain interference was lower than baseline in all patients, with significant improvement after early CPN in sleep, appetite, enjoyment of life, and mood. The average survival time of the two groups was comparable. Conclusion Early application of CT-guided CPN for patients with advanced pancreatic cancer may help reduce pain exacerbation and opioids consumption, without influencing the survival.
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Affiliation(s)
- Fan Lu
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojia Wang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Tian
- Department of Anesthesiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuehan Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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Wie C, Ghanavatian S, Pew S, Kim A, Strand N, Freeman J, Maita M, Covington S, Maloney J. Interventional Treatment Modalities for Chronic Abdominal and Pelvic Visceral Pain. Curr Pain Headache Rep 2022; 26:683-691. [PMID: 35788892 DOI: 10.1007/s11916-022-01072-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Chronic abdominal and pelvic visceral pain is an oftentimes difficult to treat pain condition that requires a multidisciplinary approach. This article specifically reviews the interventional treatment options for pain resulting from visceral abdominal and pelvic pain. RECENT FINDINGS Sympathetic nerve blocks are the main interventional option for the treatment of chronic abdominal and pelvic visceral pain. Initially, nerve blocks are performed, and subsequently, neurolytic injections (alcohol or phenol) are longer term options. This review describes different techniques for sympathetic blockade. Neuromodulation is a potential option via dorsal column stimulation or dorsal root ganglion stimulation. Finally, intrathecal drug delivery is sometimes appropriate for refractory cases. This paper will review interventional options for the treatment of chronic abdominal and pelvic visceral pain.
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Affiliation(s)
- Christopher Wie
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - Shirin Ghanavatian
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Scott Pew
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Alexander Kim
- Department of Anesthesiology Brigham and Women's Hospital, Boston, MA, USA
| | - Natalie Strand
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - John Freeman
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Mostafa Maita
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Stephen Covington
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Jillian Maloney
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Boulevard, Phoenix, AZ, 85054, USA
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Agarwal A, Gautam A, Rastogi S, Malviya D, Das PK, Harjai M. Effect of Celiac Plexus Neurolysis for Pain Relief in Patients with Upper Abdominal Malignancy: A Retrospective Observational Study and Review of Literature. Indian J Palliat Care 2020; 26:512-517. [PMID: 33623314 PMCID: PMC7888415 DOI: 10.4103/ijpc.ijpc_37_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant or non-responsive to the pharmacological management, hence minimal invasive pain intervention like celiac plexus neurolysis or splanchnic nerve rhizolysis may be required to relieve pain of such patients. Objective: The aim of this retrospective study is to assess the effect of celiac plexus neurolysis for pain relief in patients with upper gastro-intestinal malignancies. Study Design: This is a retrospective, observational study with short review. Methods: This retrospective observational study was done in the Pain Medicine unit from 2016 and November 2018. Ninety-four patients with upper abdominal malignancy and unrelenting pain, non-responsive or poorly responsive to pharmacological treatment as per WHO ladder of analgesics, received fluoroscopy-guided celiac plexus neurolysis (CPN). All the patients underwent celiac plexus neurolysis through Trans-Aortic approach and the primary outcome measure was pain as assessed with Visual Analogue Scale (VAS) ranging from 0 to 10; the secondary outcome measures were morphine consumption per day (M), quality of life (QOL) as assessed by comparing the percent of positive responses and complications, if any. These were noted and analyzed prior to intervention and then on day 1, and months 1, 2, 3, 4, 5, 6 following CPN. Results: Follow up was completed 6 months after the procedure. VAS score, daily morphine consumption, and the quality of life showed improvement for the duration of the study. There was some relapse in pain and deterioration in QOL during the fourth to sixth month of pain intervention due to disease progression. Some transient known side effects also occurred. Conclusion: Trans-Aortic celiac plexus neurolysis with low volume of alcohol is a safe procedure providing up to 6 months of pain relief and is an effective, well established, minimally invasive procedure for abdominal pain due to primary malignancy or metastatic spread.
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Affiliation(s)
- Anurag Agarwal
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Anuj Gautam
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Shivani Rastogi
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Deepak Malviya
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Praveen Kumar Das
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Mamta Harjai
- Department of Anesthesiology, CCM and Pain Medicine, Dr RMLIMS, Lucknow, Uttar Pradesh, India
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Transaortic celiac plexus block: A computed tomography simulation study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.587699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lu F, Dong J, Tang Y, Huang H, Liu H, Song L, Zhang K. Bilateral vs. unilateral endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain management in patients with pancreatic malignancy: a systematic review and meta-analysis. Support Care Cancer 2017; 26:353-359. [PMID: 28956176 DOI: 10.1007/s00520-017-3888-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/11/2017] [Indexed: 02/05/2023]
Abstract
CONTEXT Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) by bilateral or unilateral approach is widely used in palliative abdominal pain management in pancreatic cancer patients, but the analgesic effect and relative risks of the two different puncture routes remain controversial. OBJECTIVES The aim of this systematic review was to evaluate the analgesic efficacy and safety of bilateral EUS-CPN compared with unilateral EUS-CPN. METHODS An electronic database search was performed for randomized controlled trials comparing bilateral and unilateral approaches of EUS-CPN using the Pubmed, Cochrane Library, Web of Science, Google Scholar, and CNKI databases. Meta-analysis was performed using RevMan 5.3 after screening and methodological evaluation of the selected studies. Outcomes included pain relief, treatment response, analgesic reduction, complications, and quality of life (QOL). RESULTS Six eligible studies involving 437 patients were included. No significant difference was found in short-term pain relief [SMD = 0.31, 95% CI (- 0.20, 0.81), P = 0.23] and response to treatment [RR = 0.99, 95% CI (0.77, 1.41), P = 0.97] between the bilateral and unilateral neurolysis groups. However, only the bilateral approach was associated with a statistically significant reduction in the postoperative use of analgesics [RR = 0.66, 95% CI (0.47, 0.94), P = 0.02] compared to the unilateral approach. A descriptive analysis was performed for complications and QOL. CONCLUSION The short-term analgesic effect and general risk of bilateral EUS-CPN are comparable with those of unilateral EUS-CPN, but our evidence supports the conclusion that the bilateral approach significantly reduces postoperative analgesic use.
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Affiliation(s)
- Fan Lu
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55 Renmin Road South, Chengdu, 610000, Sichuan Province, People's Republic of China
| | - Jifu Dong
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55 Renmin Road South, Chengdu, 610000, Sichuan Province, People's Republic of China
| | - Yuming Tang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55 Renmin Road South, Chengdu, 610000, Sichuan Province, People's Republic of China
| | - He Huang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55 Renmin Road South, Chengdu, 610000, Sichuan Province, People's Republic of China
| | - Hui Liu
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Song
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Kexian Zhang
- Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No. 55 Renmin Road South, Chengdu, 610000, Sichuan Province, People's Republic of China.
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