Abstract No. : ABS0544 : A prospective randomised study comparing computerised tomography guided neurolytic coeliac plexus block with oral analgesic therapy in the treatment of severe pain due to pancreatic cancer

Abstract

Background and Aims:Neurolytic Coeliac Plexus block (NCPB) is a promising treatment modality apart from commonly practiced oral analgesicTherapy (OAT) for pancreatic cancer pain. The aim was to compare the efficacy of NCPB with OAT in the treatment of severe pancreatic cancer pain.Methods:Forty four patients with severe upper abdominal pain (Visual Analogue Scale(VAS) >7/10) due to unresectable pancreatic cancer were allocated randomly and equally in either NCPB group or OAT group. Patients in NCPB group were treated with 99.99% ethanol as neurolytic agent for coeliac plexus block under Computerised Tomography (CT) guidance. OAT group patients were treated with morphine tablets orally. Patients’pain intensity and opioid analgesic consumption (Oral Morphine equivalent (OME)) were assessed at day 1, 7 and 28 after the intervention. Oral morphine tablets were started in the NCPB group when the patients had severe pain after the NCPB intervention.Results:Mean baseline VAS pain scores were 8.2 and 7.9 for NCPB group and OAT group, respectively. At day 1, 7 and 28, pain scores of NCPB group were significantly lower than that of OAT group (P<0.05), 1.4±0.7 versus 3.9±0.8, 1.7±0.6 versus 3.3±0.5 and 2.1±0.8 versus 3.0±0.7, respectively(table 1). At day 1, 7 and 28, OME (mg/day) values in NCPB group were significantly lower than in OAT group (P<0.05), 8.1±0.2 versus 39.5±0.7, 12.2±0.8 versus 48.3±0.4 and 14.6±0.5 versus 57.1±0.8, respectively (table 2).Table 1Changes in visual analogue scale valuesVisual analogue scale (0-10) (mean values) Day 0Day 1Day 7Day 28NCPB group8.21.41.72.1OAT group7.93.93.33.0Table 2Oral morphine equivalent (mg/day) consumptionOral morphine equivalent (mg/day) (mean values) Day 1Day 7Day 28NCPB group8.112.214.6OAT group39.548.357.1Conclusion:CT guided NCPB is an effective treatment modality for controlling severe upper abdominal pain due to unresectable pancreatic cancer. Celiac plexus, block, pancreatic cancer