Neurolytic Celiac Plexus Block Research Articles

Outcomes of Transaortic Celiac Plexus Block for Upper Abdominal Malignancies Performed as a Day-care Procedure: A Retrospective Observational Study

Background: Severe abdominal pain refractory to opioids significantly affects the quality of life (QoL) in patients with abdominal primary cancer or metastatic disease. A neurolytic celiac plexus block (CPB) would be necessary to alleviate pain and improve QoL until death. Aims: The aim of this retrospective study is to investigate pain relief after a transaortic celiac plexus neurolysis for patients with upper gastrointestinal malignancies. Settings and Design: This retrospective observational study was done in the Pain Department, Shri Siddhivinayak Cancer Hospital, Miraj from January 2005 to January 2015. Materials and Methods: One hundred and twenty-four patients with upper abdominal malignancy received a computed trans-aortic celiac plexus block (TAoCPB) on a day-care basis. The primary outcome was pain as assessed with numerical rating scale ranging from 0 to 10; the secondary outcome measures were morphine consumption per day, QoL, and complications, if any. These were recorded before intervention, on day 1 after the block and at 1 month interval until 6 months. Statistical Analysis Used: Bonferroni correction for multiple comparisons and a P < 0.0167 (0.05/3) was considered to be statistically significant due to 3 co-primary outcomes being measured (visual analog scale [VAS] scores, morphine consumption, and QoL). Results: Up to 4.5 months, the VAS score, daily morphine consumption, and the QoL showed improvement for the duration of the study. Pain gradually increased at 6 months with a deterioration of QoL. Respiratory distress and burning sensation in chest occurred in one patient each. Conclusions: A low-volume TAoCPB is effective and established procedure as a day-care procedure. Although pain relief occurs until 4.5 months, a gradual increase was perceived with a decline of quality of health at 6 months.

Difference between Analgesic Drugs and the Coeliac Plexus Block in Relieving Pain due to Carcinoma of Pancreas: A Comparative Study

Background: Pancreatic cancer is a formidable health problem worldwide with increasing incidence. Debilitating pain is very common in patients with pancreatic cancer. The aim of this study is to observe the effectiveness of neurolytic coeliac plexus block for the relief of pain due to carcinoma of pancreas. Methods: This randomized comparative study carried out in the Department of Anaesthasia, Analgesia and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka with a period from July 2008 to June 2010 for two (2) years. Result: All patients of carcinoma pancreas >18 years of age with both sexes, who were needed palliation for their end stage carcinoma, were included in this study and were divided into two groups of which group A was taken the CPB and group B was taken the conventional treatment. A total number of 30 patients were enrolled in this study of which 15 were in the group A who were treated with the neurolytic celiac plexus block (NCPB) and 15 were in the group B who were treated with conventional analgesic drugs. Maximum were from the age group of 40 to 60 years (60.0%) in group A followed by more than 60 years (26.6 %). The mean age in the group A and group B patients were 48.73 14.26 years and 51.47 ± 12.35 years respectively (p=0.579). Both in group A and B male is predominant than female which were 12 (80%) cases and 3(20%) cases respectively (p=0.999) in each group. In group A mostly were service holder which was 8(53.3%). In group A, the mean (±SD) pain VAS before treatment is 8.80±0.86 and in group B, it is 8.07 ±1.44. The difference between this two group is not statistically significant (p=0.101). Conclusion: tthe findings of this study permit to conclude that in patients with unresectable pancreatic cancer, neurolytic celiac plexus blockade (NCPB) was associated with improved pain control, and reduced narcotic usage and constipation compared with standard treatment with clinical significance. Along with higher ..........

The Adverse Effect of Analgesics and Coeliac Plexus Block for the Relief of Pain in Carcinoma of Pancreas – A Prospective Observational Study

Introduction: Pancreatic cancer is a formidable health problem with increasing incidence. Worldwide, over 200000 people die annually of pancreatic cancer Because of high fatality rates; pancreatic cancer incidence rates are almost equal to mortality rates. Pancreatic cancer is diagnosed late in the natural history of the disease, given the few early indicators of illness, and the lack of screening tests for this disease. Neurolytic celiac plexus block (NCPB) is commonly used to treat pain of upper abdominal cancer that fails to respond to narcotic analgesics. CPB refers to the temporary inhibition of the celiac plexus often achieved with a corticosteroid injection in patients with benign pancreatic diseases like chronic pancreatitis. Aim of the study: The aim of this study was to determine and compare the adverse effect of analgesics and coeliac plexus block in relieving pain in carcinoma of pancreas. Methods: This study was a randomized comparative study and was conducted in the Department of Anesthesia, Analgesia and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2008 to June, 2009. A total number of 60 patients were enrolled in this study. All patients were divided into two groups- Group A (treated with NCPB) & Group B (treated with conventional analgesic drugs). Result: In total 60 patients from both the groups completed the study. In our study we found the majority (58%) of our patients were aged between 41-60 years old followed by 30% were aged above 60 years old. The least prevalence 5% &7% was found among <= 20 and 21-40 years old respectively. In this study we found majority of our patients were male (63%) compared to female (37%).The mean age in the group A and group B patients were 48.73 ± 14.26 years and 51.47 ± 12.35 years respectively. In our study we found after 15th day of treatment severe vomiting was 13% in group B on the other hand vomiting was absent in. 13% in group ........

Outcome of Neurolytic Coeliac Plexus Block for the Relief of Pain due to Carcinoma of Pancreas: An Observational Study

Introduction: For both patients and their families, the most concerning aspect of cancer is pain. Neurolytic Coeliac Plexus Block can be used to relief the pain of the patients with pancreatic carcinoma. Aim of the Study: The aim of this study was to assess the outcome of neurolytic coeliac plexus block for the relief of pain due to carcinoma of pancreas. Methods: This cross-sectional study was conducted in Department of Anaesthesia, Bangabandhu Sheikh Mujib Medical College, Dhaka, Bangladesh, during the period from July 2008 to June 2010. Total 50 patients with carcinoma pancreas were included in this study. Result: In this study, in group A and B the mean ± SD pain in VAS before treatment are 8.80±0.86 & 8.07±1.44 respectively. At 1st, 2nd, 7th and 15th day of treatment the mean pain in VAS of group A & group B are (2.30± 0.98 & 5.53±0.99); (2.27 ± 0.70 & 5.60 ± 1.24); (2.13± 1.13 & 6.07±1.16) and (2.27 ± 1.39 &6.40 ± 0.74) respectively. Before starting the treatment, mild anorexia was found in 7(28%) & 8(32%) cases among group A & B. Moderate anorexia was found in 10(40%) cases and 7(28%) cases in group A and group B respectively. Severe anorexia was seen in 8(32%) cases and 10(40%) cases in group A and group B respectively. In 1st day of treatment mild anorexia was found in 9(36%) and 7(28%) cases in group A and group B respectively. Moderate anorexia was found in 8(32%) and 10(40%) cases in group A and group B respectively. Anorexia was found absent by 8(32%) in both groups. At 15th day of treatment, we found mild anorexia was present in 13(52%) & 2(8%); moderate anorexia was 8(32%) & 13(52%) in group A & B respectively. Severe anorexia was found in 10(40%) cases in group B and absent in group A. Anorexia was absent in 3(12%) cases in group A and 2(8%) in group B. In group A majority of patients had moderate vomiting 10(40%) & severe vomiting 8(32%) and in group B majority of them had severe vomiting 10(40%), mild vomiting 8(32%) before starting treatment. ....

Splanchnic nerve neurolysis via the transdiscal approach under fluoroscopic guidance: a retrospective study.

BackgroundNeurolytic celiac plexus block (NCPB) is a typical treatment for severe epigastric cancer pain, but the therapeutic effect is often affected by the variation of local anatomical structures induced by the tumor. Greater and lesser splanchnic nerve neurolysis (SNN) had similar effects to the NCPB, and was recently performed with a paravertebral approach under the image guidance, or with the transdiscal approach under the guidance of computed tomography. This study observed the feasibility and safety of SNN via a transdiscal approach under fluoroscopic guidance.MethodsThe follow-up records of 34 patients with epigastric cancer pain who underwent the splanchnic nerve block via the T11-12 transdiscal approach under fluoroscopic guidance were investigated retrospectively. The numerical rating scale (NRS), the patient satisfaction scale (PSS) and quality of life (QOL) of the patient, the dose of morphine consumed, and the occurrence and severity of adverse events were recorded preoperatively and 1 day, 1 week, 1 month, and 2 months after surgery.ResultsCompared with the preoperative scores, the NRS scores and daily morphine consumption decreased and the QOL and PSS scores increased at each postoperative time point (P < 0.001). No patients experienced serious complications.ConclusionsSNN via the transdiscal approach under flouroscopic guidance was an effective, safe, and easy operation for epigastric cancer pain, with fewer complications.

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

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

Abstract No. : ABS2211

Background & Aims:Neurolytic celiac plexus block (NCPB) is a promising treatment modality apart from commonly practiced oral analgesic therapy (OAT) for pancreatic cancer pain. This study aimedto 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) score ≥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 a neurolytic agent for celiac plexus block under computerised tomography(CT) guidance. Patients in OAT group were treated with morphine tablets given orally. Patients’ pain intensity (VAS) 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 patients developed severe pain after the intervention.Results:Mean baseline VAS 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 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. At day 1, 7 and 28, OME (mg/day) values of NCPB group were significantly lower than 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.Conclusion:CT guided NCPB is an effective treatment modality for controlling severe upper abdominal pain due to unresectable pancreatic cancer.

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study.

BackgroundPrior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain.MethodsA retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB.ResultsAmong the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB.ConclusionsCeliac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

This Month in Anesthesiology

This Month in Anesthesiology

A comparative study of transdiscal versus transaortic celiac plexus neurolytic block for upper gastrointestinal cancer patients. A prospective, randomized control study

Aim: To compare transdiscal and transaortic techniques of neurolytic celiac plexus block for upper gastrointestinal cancer patients. Methods: In this prospective randomized study 60 patients with upper gastrointestinal malignancies were included and randomly divided into two groups, group TD and group TA, receiving neurolytic celiac plexus blocks via transdiscal and transaortic techniques, respectively. The primary outcome was quality of life (QoL) as assessed by WHOQOL BREF questionnaire and secondary outcomes were pain relief using visual analogue scale (VAS), and occurrence of complications like hypotension, loose motion, bleeding and discitis. Result: QoL and VAS score were significantly improved in both groups post procedure. Transdiscal approach is more effective in improving VAS score than transaortic approach (1 vs 3) after 1 week and the relief of pain was better in TD group (3 vs 6) at the end of 2 months. Transdiscal approach was found to be more effective in improving QoL (227.00±28.85 vs 191.17±35.78) as compared to transaortic approach. However, post-procedural QoL improved in both groups when compared to pre-procedural QoL (p&lt;0.05). Hypotension, diarrhea and bleeding from aorta were higher in TA group; however, no serious complications were seen in any of the groups. Conclusion: Transdiscal technique is better in terms of adequate pain relief and improving QoL as compared to transaortic technique of NCPB in patients of upper GI malignancies and is associated with lesser incidences of complications.

Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report

BackgroundEmergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors.Case presentationA 66-year-old male patient was found to have pancreatic tail neoplasm upon computed tomography (CT) examination. The surgeon planned to resect the pancreatic tail under general anesthesia. However, the surgeon found extensive tumor metastasis in the abdominal cavity, and thus performed a neurolytic celiac plexus block (NCPB) with 40 ml 95% ethyl alcohol and finished the surgery in approximately 1 h. Twenty minutes later, the patient was extubated and developed significant emergence agitation in the postoperative care unit, characterized by restlessness, uncontrollable movements, confusion and disorientation. The patient was flushed and febrile with an alcohol smell in his breath and was unable to follow commands. Patient symptoms were suspected to be due to acute alcohol intoxication. Thus, the patient was given 40 mg of propofol intravenously. Following treatment, the patient recovered with less confusion and disorientation after approximately 10 min. After treatment with propofol twice more, he regained consciousness, was calm and cooperative, had no pain, and could obey instructions approximately 1 h and 40 min following the last treatment. Following this treatment, the patient was transferred to the inpatient ward and felt well.ConclusionsIt is paramount to correctly identify the underlying cause of emergence agitation in order to successfully manage patient symptoms, since treatment plans vary between different etiological causes. Emergence agitation may be due to acute alcohol intoxication after intraoperative use of alcohol.

Pathogenesis and Treatment of Pancreatic Cancer Related Pain.

Pancreatic cancer is often diagnosed due to the patient seeking medical attention for abdominal pain. It is among the most painful cancers, with pain severity strongly correlating with prognosis. Perineural invasion is a prominent feature of pancreatic cancer and often the first route of metastasis resulting in neuropathic pain. While surgical pain is present, it is generally short-lived; chemo- and radio-therapy associated side effect pain is often longer lasting and more difficult to manage. Treatment-induced mucositis in response to chemotherapy occurs throughout the GI tract resulting in infection-prone ulcers on the lip, buccal mucosa, palate or tongue. Cisplatin treatment is associated with axonal neuropathy in the dorsal root ganglion, although other large sensory fibers can be affected. Opioid-induced hyperalgesia can also emerge in patients. Along with traditional means to address pain, neurolytic celiac plexus block of afferent nociceptive fibers has been reported to be effective in 74% of patients. Moreover, as cancer treatments become more effective and result in improved survival, treatment-related side effects become more prevalent. Here, pancreatic cancer and treatment associated pain are reviewed along with current treatment strategies. Potential future therapeutic strategies to target the pathophysiology underlying pancreatic cancer and pain induction are also presented.

Time-dependent change in pain threshold following neurolytic celiac plexus block.

Aim: To determine the long-term effect of ethanol relative to the re-occurrence of pain in postneurolytic celiac plexus block (NCPB) patients. Patients & methods: A noninterventional study on 31 patients who had undergone NCPB to illustrate the average change of pain score over time. Results: All NCPB patients reported a pain score decrease of 83.8% right after the procedure. 73% of patients reported 50-66% decrease in pain 80-100 days postprocedure. The temporal threshold for the return of pain scores to average preblock level was determined to be 103 post-NCPB procedure days. Conclusion: In this study, NCPB patients demonstrate return of pain to baseline subsequent to the analgesic effects of ethanol after a mean 103 days.

Is quality of life improved by neurolytic coeliac plexus block in pancreatic cancer pain management?

Pancreatic cancer (PC) is a disease of insidious onset and late clinical presentation with an annual incidence of 100 per million population. Itis the sixth most common cause of mortality from cancer and records a median survival of about 3–6 months without treatment. Quality of life (QOL) is the major consideration in the management of advanced cancer. PC adversely affects QOL of sufferers and mostly presents with abdominal pain from intra- and extra-pancreatic origins. Opioids are the “Gold-standard” treatment in severe cancer pain management. However, its use may be challenged by debilitating side effects such as drowsiness, respiratory depression, constipation, nausea/vomiting, or opioid toxicity which further worsens QOL of patients burdened with cancer. Neurolytic coeliac plexus block (NCPB) is indicated in PC pain that is resistant or refractive to conventional analgesic methods. Such potent analgesic technique could ease the suffering of cancer patients and provides an improved QOL. Reports indicate that NCPB provides effective analgesia in advanced PC but might be associated with minor and transient side effects such as hypotension, diarrhea, and retroperitoneal hemorrhage. Reports from studies analyzed in this review show that NCPB provides superior analgesia in PC pain management than opioid-based therapies. However, there is no satisfactory evidence that NCPB improved QOL in these patients. This shows that QOL of advanced cancer patients is not synonymous with pain relief. Improvement in QOL will be difficult without management of the “total pain” felt by the patients.

Low Volume Neurolytic Retrocrural Celiac Plexus Block for Visceral Cancer Pain: Retrospective Review of 507 Patients with Severe Malignancy Related Pain Due to Primary Abdominal Cancer or Metastatic Disease

Abdominal pain from primary cancer or metastatic disease is a significant cause of pain for patients undergoing treatment for the disease. Patient's pain may be resistant to conventional analgesics. The need for timely pain relief in order to facilitate further care in the cancer treatment plan should be a priority. The aim of this retrospective observational review was to assess the relief given with a low volume neurolytic retrocrural celiac plexus nerve block, the duration of the procedure, the duration of relief, the reduction in daily opioid consumption, and the improvement of quality of life in a patient suffering from incapacitating abdominal pain due to primary abdominal malignancy or abdominal metastatic disease. Patients were given a neurolytic celiac plexus block without previous diagnostic block due to multiple comorbidities. This is a retrospective, observational study. Five hundred and seven patients were studied and data at 5 months for 455 patients were retained at the end of the review. They were evaluated in the pain center prior to and after the neurolytic retrocrural celiac plexus nerve block under fluoroscopic guidance. They were assessed on duration of procedure, pain scores (numeric rating scale 0-10), daily opioid consumption, quality of life improvement (simple yes or no question at 3 months) and routine follow-up during treatment for the cancer for 6 months or end of life. All data was gathered by extensive chart review and placed on a spreadsheet for analysis. Follow-up was completed 6 months after the procedure. Pain scores, daily opioid consumption, and quality of life showed improvement for the duration of the study. There was some return in pain during the fourth to sixth month due to disease progression and the anticipated duration of the neurolytic agent. Some short duration known side effects did occur. An initial vascular contrast uptake of 6.7% was noted during the procedure while utilizing digital subtraction angiography with fluoroscopy. A larger sample size would be ideal, as well as, a prospective trial with a control group, but this is unrealistic in our patient population. A proven quality of life questionnaire would be beneficial. Comparing alcohol, phenol and radiofrequency thermocoagulation would be interesting to equate duration, effect, and side effects. Low volume neurolytic retrocrural celiac plexus nerve block with phenol is a safe procedure providing up to 6 months of pain relief and is an effective, well-established, minimally time-consuming procedure for abdominal pain due to primary malignancy or metastatic spread. Celiac plexus, neurolytic, abdominal cancer pain, pain, retrocrural, cancer pain.

Predictors of analgesic efficacy of neurolytic celiac plexus block in patients with unresectable pancreatic cancer: the importance of timing.

Neurolytic celiac plexus block (NCPB) is a safe and effective method for reducing abdominal cancer pain. However, the analgesic efficacy of NCPB is not always guaranteed. The aim of this retrospective study was to identify predictors for the analgesic efficacy of NCPB in patients with unresectable pancreatic cancer. Patients with unresectable pancreatic cancer who underwent NCPB from 2006 to 2015 were enrolled. Good analgesia after NCPB was defined as ≥ 50% reduction in pain score at day 30. Patient demographics, cancer characteristics, and pain-related factors were evaluated using a logistic regression analysis to identify predictors for good analgesia after NCPB. Additionally, survival outcomes were compared between patients with poor and good analgesia after NCPB. A total of 112 patients satisfied the study protocol requirements. Forty-seven patients (41.9%) showed good analgesia after NCPB. Better performance status, lower serum CA 19-9 level, shorter pain duration, and lower opioid dose were observed in patients with good analgesia after NCPB. Good performance status (ECOG performance status 1 vs. 2 or 3, OR = 2.737, 95% CI = 1.149 to 6.518, P = 0.023) and low daily opioid use (< 150 vs. ≥ 150mg, OR = 2.813, 95% CI = 1.159 to 6.831, P = 0.022) before NCPB were independent predictors of good analgesia after NCPB. The median survival was significantly lower for patients with poor analgesia after NCPB (68 vs. 150days, P < 0.001). NCPB should be offered early to selected patients to improve its analgesic efficacy in advance of deterioration from disease and pain in this population.

The Role of Laparoscopy and Laparoscopic Ultrasound in Staging and in Palliation of Upper Gastro-Intestinal Malignancies: The Egyptian National Cancer Institute Experience

Background: Surgical resection of upper gastrointestinal malignancies occasionally carries substantial morbidity due to inaccurate pre-operative staging. The potential to prevent needless laparotomy by means of precise staging is the pouring force behind the use of diagnostic laparoscopy (DL). Objective: To assess the role of laparoscopy and laparoscopic ultrasound (LUS) in proper staging of upper gastro intestinal malignancies, and in potential palliation in advanced cases for pain (by neurolytic celiac plexus block) or gastric outlet obstruction (by laparoscopic bypass surgery). Study design: In this prospective study, 62 patients with lower esophageal, gastric and peri-pancreatic carcinomas were joined after written informed consent. All patients were examined with laparoscopy and LUS with the help of frozen section analysis to any doubtful metastatic site, peritoneal fluid and ascitic fluid analysis. Results: DL helped us to avoid needless laparotomy in 22.5% of patients, reducing its post-operative complications, hospital stay and cost. DL also helped us to do palliative management either in the form of gastric bypass or laparoscopic celiac plexus block. Conclusion: we praise the use of DL as a safe, effective and complimentary method to the other routine imaging modalities, in proper staging and palliation for upper gastrointestinal malignancies.

Patient Presents with Pancreatic Cancer

Cancer pain is complex and challenging to treat. Pancreatic cancer pain occurs in 75% of patients and over 90% of patients in advanced stages. Pain management should be individual to the patient and involve a multidisciplinary approach. No one treatment modality has been found to be effective in alleviating pancreatic cancer pain; therefore, all treatment options should be considered. Opioids are a cornerstone of cancer pain management; however, the neurolytic celiac plexus block can be a useful treatment modality in pancreatic cancer patients. This review discusses the types of pain that are seen in pancreatic cancer patients and how to treat that pain through a multimodal, multidisciplinary approach. This review contains 3 figures and 28 references.

Effectiveness of Percutaneous Celiac Plexus Ablation in the Treatment of Severe Cancer Pain in Upper Abdomen and Evaluation of Health Economics.

To compare the effectiveness, adverse effects, and cost-effectiveness of percutaneous neurolytic celiac plexus block (NCPB) versus traditional medication strategies for the treatment of patients with advanced cancer having severe upper abdominal cancer pain. This retrospective study included 81 patients with advanced upper abdominal cancer admitted to The Sixth People's Hospital Affiliated to Shanghai Jiaotong University between January 2013 and July 2014. The patients were divided into percutaneous NCPB (treatment) and medication for pain (control) groups. The outcomes were measured in terms of Numeric Rating Scale (NRS) score and Karnofsky Performance Status (KPS) score before treatment and on the 3rd, 7th, 14th, and 28th days posttreatment. The effectiveness and cost-effectiveness of the therapy were assessed using analysis of the health economics. The improvements in NRS score (1.42 ± 1.09 vs 4.03 ± 0.96, P < .01) and KPS score (65.55 ± 9.09 vs 63.03 ± 8.961, P < .01) in the treatment group were significantly superior compared to the control group on the 7th day of treatment, followed by no significant difference between the 2 groups on the 14th and the 28th day of treatment. Health economics evaluation revealed that the medicine-specific costs and total health care costs were significantly reduced in the treatment group compared to the control group ( P < .05), but no significant differences between the 2 groups ( P > .05) were seen in the costs of hospitalization, examinations, and treatment. The percutaneous NCPB method shows promising results and better cost-effectiveness for treating patients with advanced cancer having severe upper abdominal pain.

Neurolytic Celiac Plexus Block Efficacy in Patients with Severe, Chronic Upper-abdominal Cancer Pain

Objectives: To study of the efficacy of the neurolytic celiac plexus block (NCPB) in patients with severe, chronic upper-abdominal cancer pain in reducing pain score, morphine consumption, side effects of morphine, and improving performance score. Methods: Fifty-six patients with abdominal cancer who suffered chronic, severe pain were enrolled in this study. All patients received a morphine dose of &lt;100mg/day. Patients were divided into 2 groups: group I included patients who received NCPB, group II included patients who used morphine continuously. The patients' pain score, performance status, morphine consumption and morphine-related side effects were recorded at regular two-week intervals with a final follow-up at eight weeks. Results: After the NCPB administration, the pain score, morphine consumption and morphine-related side effects decreased in group I more than in group II (p &lt;0.0001). The physical performance improved in group I more than group II (p&lt;0.001). In group II, pain scores were consistently elevated and patients continued to receive high doses of opioids with inadequate pain control (p &lt;0.001). In group I, morphine-related side effects (nausea, anorexia, and constipation) had lower grades than in group II (p &lt;0.001). Conclusion: NCPB is one of the choices for palliation of severe, chronic upper-abdominal cancer pain.