Comparison of efficacy of three kinds of neurolytic celiac plexus block in patients with upper abdominal cancer pain

Abstract

Objective To compare the efficacy of three kinds of neurolytic celiac plexus block (NCPB) in the patients with upper abdominal cancer pain. Methods Sixty-seven patients of both sexes, with upper abdominal cancer, aged 45-64 yr, weighing 52-69 kg, were randomly divided into 3 groups using a random number table: single-needle NCPB using crura of diaphragm space approach group (group S, n=23), double-needle NCPB via an anterior and posterior crura of diaphragm space approach group (group D, n=22), and continuous NCPB via crura of diaphragm space approach group (group C, n=22). In S and D groups, NCPB was performed with single injection of anhydrous alcohol 25-30 ml after CT-guided successful single and double punctures, respectively.In group C, a catheter was inserted into the crura of diaphragm space and then anhydrous alcohol 25-30 ml was injected via the catheter once a day for 3 consecutive days to perform NCPB.Before treatment, at 1 week after treatment, 1, 2, 4 and 6 months after treatment, the daily consumption of morphine and VAS score were recorded.The therapeutic efficacy was evaluated using VAS weighted value calculation.The development of adverse effects such as diarrhea, hypotension, dysuria and damage to nerves was recorded. Results Compared with S or D groups, the daily consumption of morphine was significantly decreased at 4-6 months after treatment, the rate of effective treatment was increased at 4-6 months after treatment, and the incidence of hypotension was decreased in group C. The incidence of diarrhea was significantly higher in D and C groups than in group S. Conclusion For the patients with upper abdominal cancer pain, continuous NCPB via crura ofdiaphragm space approach provides perfect efficacy with fewer adverse reactions, and the efficacy is better than that of single-needle NCPB using crura of diaphragm space approach or double-needle NCPB via an anterior and posterior crura of diaphragm space approach. Key words: Celiac plexus; Nerve block