Celiac plexus block for cancer pain

Abstract

Pancreatic cancer is the fourth most common cause of cancer-related death in the United States, with an estimated 27,800 new cases in 1996. Pain is the most common presenting symptom, which remains prevalent in 80% to 85% of advanced pancreatic cancer cases. There is increasing evidence that neurolytic celiac plexus block (CPB) is an effective method to treat pain associated with intra-abdominal malignancies, especially pancreatic cancer. In addition, a recent study suggests that pain control with splanchnic neurolysis (similar to CPB) may improve survival time in certain pancreatic cancer patients. There are two basic approaches to perform CPB, which differ depending on the final needle placement relative to the diaphragm. The first approach is the retrocrural block (“classic” CPB or deep splanchnic nerve block), in which the injectate spreads posterior to the diaphragm. On the other hand, the second approach is the anterocrural block (“true” CPB), which results in the spread of injectate anterior to the diaphragm. Alcohol and phenol, in combination with a local anesthetic, are the most commonly used agents for neurolysis in CPB. Neurolytic CPB has been used extensively with good benefit and limited risk of adverse effects.