Efficiency of Image Guided Percutaneous Celiac Plexus Neurolysis in Abdominal Malignancy: A Prospective Interventional Study

Abstract

Introduction: Celiac Plexus Neurolysis (CPN) is an underutilised tool in oncology and interventional radiology set-up. Upper abdominal malignancy specifically carcinoma pancreas, carcinoma stomach which causes intolerable pain, for which patients require a high dose of pain killers. CPN being a day care procedure alleviates the pain in a short duration and its effectiveness may last for months. Aim: To assess the efficiency of image guided CPN in alleviating intractable pain in upper abdominal malignancy. Materials and Methods: A prospective interventional study was conducted on 25 patients with inoperable upper abdominal malignancy with intractable pain referred from the Palliative Care Department. These patients were subjected to Computed Tomography (CT)-guided or Ultrasonography (USG)-guided CPN using 97% absolute alcohol either via posterior or anterior approach under CT guidance or anterior approach in USG guidance. Pain intensity score was assessed before and after the procedure (one, three, and seven days after the procedure) using Visual Analogue Scale (VAS). Results: There was decrease of the pain intensity significantly in all the patients postprocedure. The VAS score at baseline was 6.48±1.56. One day after CPN, pain severity decreased to 4.16±2.17; three days later, it was 1.68±1.78; Seven days after CPN, pain severity still decreased significantly to 0.58±1.10. Percentage decrease in VAS from preprocedure to one, three, and seven days after procedure was found to be 39.07%, 76.29% and 90.06%, respectively and VAS score reduction was statistically significant at p-value <0.001. Conclusion: CPN is an underutilised palliative procedure for upper abdominal malignancy which effectively controls pain, thus, reducing the need for analgesic medication. Both CT guidance and USG guidance can be used in performing the procedure.