Assessment of Celiac Plexus Block and Neurolysis Outcomes and Technique in the Management of Refractory Visceral Cancer Pain

Michael A. Erdek, MD

Assistant Professor of Anesthesiology and Critical Care Medicine and Oncology
The Johns Hopkins University School of Medicine
Director of Quality Improvement for the Division of Pain Medicine
Baltimore, Maryland
Objective. To assess demographic and clinical factors associated with celiac plexus neurolysis outcomes. Design. Retrospective clinical data analysis. Setting. A tertiary care, academic medical center. Patients. Forty-four patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures. Interventions. Fifty celiac plexus alcohol neurolytic procedures done for pain control after a positive diagnostic block. Outcome Measures. A successful treatment was predefined as >50% pain relief sustained for >/=1 month. The following variables were analyzed for their association with treatment outcome: age, gender, duration of pain, origin of tumor, opioid dose, type of radiological guidance used, single- vs double-needle approach, type of block (e.g., antero- vs retrocrural), immediate vs delayed neurolysis, volume of local anesthetic employed for both diagnostic and neurolytic blocks, and use of sedation. Results. Those variables correlated with a positive outcome included lower opioid dose and the absence of sedation. Strong trends for a positive association with outcome were found for the use of computed tomography (vs fluoroscopy), and using <20 mL of local anesthetic for the diagnostic block. Conclusions. Celiac plexus neurolysis may provide intermediate pain relief to a significant percentage of cancer sufferers. Both careful selection of candidates based on clinical variables, and technical factors aimed at enhancing the specificity of blocks may lead to improved outcomes.

References

Assessment of Celiac Plexus Block and Neurolysis Outcomes and Technique in the Management of Refractory Visceral Cancer Pain. Pain Med. [Epub ahead of print]

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