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PubMed2001

Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience.

OBJECTIVE: In our previous randomized trial, we suggested a possible role for endoscopic ultrasound (EUS) guided celiac plexus block in the treatment of abdominal pain associated with chronic pancreatitis. The purpose of this study was to evaluate our prospective experience with EUS-guided celiac plexus block for controlling pain attributed to chronic pancreatitis, including follow-up on response rates and complications. METHODS: All subjects enrolled had documented chronic pancreatitis by ERCP and EUS criteria and presented with chronic abdominal pain unresponsive to current treatment options. All were treated with EUS-guided celiac plexus block under the guidance of linear array endosonography using a 22-gauge FNA needle (GIP, Mediglobe Inc., Tempe, AZ) inserted on each side of the celiac area, followed by injection of 10 cc bupivacaine (0.25%) and 3 cc (40 mg) triamcinolone on each side of the celiac plexus. Individual pain scores, based on a visual analog scale (0-10), were determined preblock and postblock by a nurse at 2, 7, 14 days and monthly thereafter. Subjects also rated their overall comfort level during the EUS procedure. RESULTS: EUS-guided celiac plexus block was performed in 90 subjects (40 males, 50 females) having a mean age of 45 yr (range 17-76 yr) between July 1, 1995 and December 30, 1996. A significant improvement in overall pain scores occurred in 55% (50/90) of patients. The mean pain score decreased from 8 to 2 post EUS celiac block at both 4 and 8 wk follow-up (p < 0.05). In 26% of patients there was persistent benefit beyond 12 wk, and 10% still had persistent benefit at 24 wk, including three patients who were pain-free between 35 and 48 wk. Younger patients (<45 yr of age) and those having previous pancreatic surgery for chronic pancreatitis were unlikely to respond to the EUS-guided celiac block. Three patients experienced diarrhea post EUS celiac block, which resolved in 7-10 days; however, it is unclear whether this diarrhea was due to the block or to refractory disease. A cost comparison between the EUS ($1200) and CT ($1400) techniques shows the EUS celiac block to be less costly and perhaps more cost efficient in a subset of subjects. CONCLUSIONS: EUS-guided celiac plexus block appears to be safe, effective, and economical for controlling pain in some patients with chronic pancreatitis. Younger patients (<45 yr) and those having prior pancreatic surgery for chronic pancreatitis do not appear to benefit from this technique. Prophylactic antibiotics should be considered if acid suppressing agents are being taken.

Abdominal Pain↗

PubMed2000

Celiac plexus block in cancer pain management.

The neurolytic celiac plexus block (NCPB) has been recommended for pain relief in patients with upper abdominal cancer by the WHO Cancer Pain Relief Program. In this article, we review the indications, techniques, and adverse effects of NCPB based on the previous findings in the literature and our own experience of 142 NCPBs during the past 11 years. No well-validated indication criteria for the NCPB have been available from invasive trials or non-invasive pain evaluations. Thus, the procedure has been employed using comprehensive pain assessment. Several modified approaches have been described for NCPB with differences in the target space where the alcohol is injected (precrural and retrocrural) and the insertion route of the needle (posterolateral and transdiscal). We have used the retrocrural transdiscal approach because of its simplicity and safety. The efficacy of the resultant pain relief does not differ among these techniques. Therefore, whether a distinction exists between blocks of the celiac plexus and those of the splanchnic nerves is controversial. The term "peri-aortic nerve block" may better describe the feature of this neurolytic intervention. The noteworthy adverse effects of alcoholic neurolysis include regional pain, hypotension, diarrhea, hypoxemia, and acute alcoholic intoxication. Most of them are transient and controllable. The diarrhea may counteract the morphine-induced constipation. NCPB relieves visceral pain in upper abdominal cancer with no serious adverse effects. We recommend this procedure to improve the quality of life of the patients suffering from abdominal cancer pain.

Abdominal Neoplasms↗

PubMed1991

[Celiac plexus block: value of x-ray computed guidance].

Celiac plexus block is a good alternative of pain treatment in upper abdominal pain. Neurolysis of the celiac plexus by the percutaneous posterior route used CT guidance in 8 patients. Pain relief was obtained in 5 of 7 patients (70 per cent); no complication occurred.

Abdominal Pain↗

PubMedDate not supplied

Plasma alcohol concentrations after celiac plexus block in gastric and pancreatic cancer.

OBJECTIVE: The objective of this study was to compare the plasma alcohol concentrations after celiac plexus block in different types of cancer. The authors studied the consecutive changes of plasma alcohol concentrations after celiac plexus block in a gastric cancer group (group 1, n = 6) and a pancreatic cancer group (group 2, n = 5). METHOD: Celiac plexus block was performed with 10 ml of absolute ethyl alcohol. In all patients, operations had been performed 1.2-3.5 years before the block. Arterial blood was sampled at 0, 5, 10, 15, 30, 60, 120, 240, and 480 minutes after the block. RESULTS: The average dose of absolute ethyl alcohol was 0.186 g/kg in group 1 and 0.182 g/kg in group 2. Plasma alcohol concentrations in group 1 were about four times greater than those of group 2 (p < 0.01). The mean maximum level was reached at 15 minutes after injection in group 1 (44.0 +/- 5.8 mg/dl) and at 30 minutes in group 2 (13.1 +/- 2.4 mg/dl). CONCLUSION: Plasma alcohol concentrations after celiac plexus block showed different patterns according to the site of cancer and the type of operation performed.

Adult↗

PubMedDate not supplied

CT-guided percutaneous neurolytic celiac plexus block technique.

Up to now, the studies in the world have demonstrated that CT-guided percutaneous neurolytic celiac plexus block (PNCPB) is an invaluable therapeutic modality in the treatment of refractory abdominal pain caused by cancer. Its efficacy of pain relief varied in reported studies. The main technical considerations which would affect the analgesic effects on abdominal pain included the patients' cooperation, needle entry approaches, combined use of blocking approaches, localization of the target area, dosage of the blocker, and so on. A success of PNCPB depends greatly on close cooperation with patients. The patient should be educated about the purpose and steps of the procedure, and trained of breathing in and breathing hold. The needle entry can be divided into the posterior approach and the anterior approach. The former one is the most commonly used in clinical practice, but the latter one is rarely used except in the cases that the posterior approach becomes technically difficult. Bilateral multiple blocking of celiac plexus and splanchnic nerves is often required to achieve optimal analgesia. The needle entry site, insertion course, and depth should be preselected and simulated on CT monitor prior to the procedure in order to ensure an accurate and safe celiac plexus block. The magnitude of analgesic effect is closely related to the degree of degeneration and necrosis of the celiac plexus. Maximally filling with blocker in the retropancreatic space is an indication of sufficient blocking. We also provided an overview of indications and contraindications, preoperative preparations, complications and its treatment of PNCPB.

Abdominal Pain↗

PubMed1992

[Appropriate puncture site for CT monitored celiac plexus block determined from CT films].

We investigated appropriate puncture site, angle of needle entry, and the distance of the insertion for CT monitored celiac plexus block using CT photograms on prone position in sixteen patients with gastrointestinal diseases. In retrocrural approach during CT monitored celiac plexus block, the average distances of puncture sites to midline were 3.84 cm on the right and 4.06 cm on the left, and the average needle angles were 74.1 degrees on the right and 76.9 degrees on the left. The average depths from the puncture site to marked position in retrocrural space were 7.88 cm on the right and 7.85 cm on the left. The rates of predicted organ puncture when needle is inserted 7 cm lateral to the midline of the spinal process were 43.8 percent in the right lung, 12.5 percent in the left lung, 56.2 percent in the right kidney and 68.8 percent in the left kidney. From these results, we found high possibilities of organ injuries using the conventional technique for celiac plexus block. We conclude that we could perform celiac plexus block more safely and surely using the retrocrural approach by CT monitoring, as serious complications are avoidable by viewing ideal puncture course on CT photographs.

Aged↗

PubMed1991

Improving palliation in pancreatic cancer: intraoperative celiac plexus block for pain relief.

Most patients with pancreatic carcinoma are not curable. Surgical palliation of obstructive jaundice and gastric outlet obstruction leaves many patients with severe pain from pancreatic carcinoma. Anesthesiologists have drawn increasing attention to the successful use of postoperative percutaneous celiac plexus block for the treatment of pancreatic pain. Ironically, little attention has been paid to celiac plexus block during laparotomy. We reviewed the cases of 12 patients with pancreatic carcinoma and severe abdominal pain who were treated surgically. All patients had operative celiac plexus block with absolute alcohol at the time of exploratory laparotomy for biliary bypass, gastroenterostomy, or tumor biopsy. Complete postoperative pain relief was obtained in 10 of the 12 patients; two had only partial relief. No operative complications were related to celiac plexus block; one patient died postoperatively of pneumonia. Average postoperative hospital stay was 13 days and average postoperative survival was 3 1/2 months. Most patients had excellent pain relief for at least 2 months or until death. Because most patients treated surgically for pancreatic carcinoma are receiving only palliation with biliary bypass or gastroenterostomy, surgeons should pay increased attention to pain relief. Operative celiac plexus block is easy, safe, and highly effective in relieving the agonizing pain of pancreatic carcinoma.

Adult↗

PubMed1993

Celiac plexus block versus analgesics in pancreatic cancer pain.

Twenty pancreatic cancer patients were studied to assess the effectiveness and duration of celiac plexus block compared to traditional treatment with analgesics by considering the previous and subsequent consumption of narcotics until their death. After 1 week of therapy with NSAID-narcotic sequence according to the WHO method, 10 patients were continued on this treatment, while the other 10 patients underwent celiac plexus block. Subsequently analgesics were administered as in the patients not treated by the block. A visual analogue score and opioid consumption were used to calculate the effective analgesic dose at weekly intervals until death. Celiac plexus block made pain control possible with a reduction in opioid consumption for a mean survival period of about 51 days. Administration of only analgesics resulted in an equal reduction in VAS pain score until death, but with more unpleasant side effects than when using celiac plexus block.

Adult↗

PubMed1992

[Cytophotometric and electrophysiologic analysis of the role of the celiac plexus in maintaining temperature homeostasis in cold stress in rats].

The role of the celiac plexus in maintaining temperature homeostasis in rats during cold stress was studied histochemically, ultrastructurally, and electrophysiologically. Inhibition on efferent impulses in preganglionic (splanchnic) nerves and facilitation in postganglionic (superior mesenteric) nerves during a short-term cold exposure leading to slight hypothermia were found. In cold-exposed animals after the celiac plexus decentralization, the neurons showed an increase in the fluorescence intensity and activity of energy metabolism enzymes, hyperplasia of fine structures responsible for protein synthesis and energy supply of cells. It is suggested that during cold stress when efferent impulse flow in preganglionic nerves markedly decreases, the celiac plexus becomes a regulatory centre for autonomic functions involved in the maintenance of temperature homeostasis.

Animals↗

PubMed1993

Percutaneous neurolysis of the celiac plexus via the anterior approach with sonographic guidance.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of sonographically guided percutaneous neurolysis of the celiac plexus in patients with abdominal tumors or chronic pancreatitis in whom systemic analgesics were ineffective. SUBJECTS AND METHODS: Neurolysis of the celiac plexus was performed in 38 patients, 34 with neoplastic disease and four with chronic pancreatitis. Under sonographic guidance, a 22-gauge needle was advanced by the anterior route to the area above the celiac plexus, and 30-40 ml of 50% alcohol was injected. Pain relief was assessed 1 week, 6 months, and 1 year after the procedure. Patients subjectively rated the pain after treatment as totally relieved, partially relieved, or unchanged. RESULTS: At 1 week and at 6 months after treatment, pain was totally relieved in 61% of patients, partially relieved in 31%, and unchanged in 8%. After 1 year, pain was totally relieved in 39%, partially relieved in 52%, and unchanged in 9%. The complications observed were five cases of mild diarrhea and one case of retroperitoneal pain, which subsided with conservative treatment. CONCLUSION: The anterior, sonographically guided approach appears to be as successful as other percutaneous techniques for neurolysis of the celiac plexus.

Abdominal Neoplasms↗

PubMed2000

Efficacy of neurolytic celiac plexus block in varying locations of pancreatic cancer: influence on pain relief.

BACKGROUND: Neurolytic celiac plexus block (NCPB) is an effective way of treating severe pain in some patients with pancreatic malignancy. However, there are no studies to date that evaluate the effectiveness of NCPB related to the site of primary pancreas cancer. The aim of the study was to assess the effectiveness of NCPB in pancreatic cancer pain, depending on the location of the pancreatic tumor. METHODS: The prospective study was conducted in 50 consecutive patients diagnosed with pancreatic cancer. The patients were categorized into two different groups depending on tumor localization: group 1: patients with the cancer of the head of the pancreas and group 2: patients with the cancer of the body and tail of the pancreas. The qualitative and quantitative pain analyses were performed before and after NCPB. The patients underwent prognostic celiac plexus block with bupivacaine, followed by neurolysis during fluoroscopic control within the next 24 h. RESULTS: After NCPB, 37 patients (74%) had effective pain relief during the first 3 months or until death. Of the 37 patients who had effective pain relief, 33 (92%) were from group 1 and 4 (29%) were from group 2. In the remaining 13 patients (3 patients from group 1 and 10 patients from group 2), pain relief after NCPB was not satisfactory. Those patients were scheduled for repeated retrocrural neurolysis during computed tomography control. Computed tomography showed massive growth of the tumor around the celiac axis with metastases. After repeated neurolysis, pain relief clinically still was not satisfactory, necessitating additional opioid treatment. CONCLUSION: In this study, unilateral transcrural celiac plexus neurolysis has been shown to provide effective pain relief in 74% of patients with pancreatic cancer pain. Neurolysis was more effective in cases with tumor involving the head of the pancreas. In the cases with advanced tumor proliferation, regardless of the technique used, the analgesic effects of NCPB were not satisfactory.

Adult↗

PubMed1980

Celiac plexus block: diagnostic and therapeutic applications in abdominal pain.

The celiac plexus block has been "rediscovered" by the modern multidisciplinary pain clinic. Local anesthetic blocks aid in diagnosing unusual syndromes of abdominal pain. Neurolytic blocks are important in the management of intractable pain from abdominal cancer. Therapeutic use of celiac plexus block in managing the pain of chronic pancreatitis has been expanded by the use of intraplexus steroids. This treatment carries less morbidity than surgical interventions and affords long-term pain relief.

Abdomen↗

PubMed2000

[Ultrasound guidance technique in celiac plexus block].

The aim of our study was to describe the technique and the efficacy of ultrasound-guidance for celiac plexus block in cancer patients in our institution Antoine Lacassagne Center. Celiac plexus block was performed in 13 cancer patients under ultrasound-guidance (n=13). All patients had excruciating epigastric and generalized abdominal pain caused by cancer. Feasibility and complication rates were analyzed. Notable pain relief was obtained in 9/13 (69%) of the patients and the technical success rate was 93% (12/13). There were 2 minor complications: orthostatic arterial hypotension (n=1) and transient left shoulder pain (n=1). Color Doppler sonography improved visualization of the 21 Gauge Chiba needle when the needle shaft was vibrated. Echogenic foci were observed around the origin of the celiac trunk and superior mesenteric artery in all cases. Ultrasound guidance is safe and effective and should be attempted for celiac plexus block whenever possible.

Abdominal Neoplasms↗

PubMed1981

[The participation of the celiac plexus in the innervation of the bronchi and pulmonary vessels].

Nerves and receptors of the bronchial and vascular walls have been studied in dogs, cats and rabbits after extirpation of the celiac plexus, subdiaphragmatic vagotomy and cutting the celiac plexus under the diaphragm. In all the animals operated on and sacrificed 16 h-9 days later, besides intact nerves, there were many neural fibres and receptors reactively and destructively changed. Some neural elements were at the state of Waller's decomposition. Owing to the data obtained, it is possible to conclude that the celiac plexus and the abdominal part of the vagus nerve and that of the celiac nerve participate in innervation of the bronchi and the pulmonary vessels.

Animals↗

PubMed1997

Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions?

BACKGROUND: The "single-needle" celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated. METHODS: Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long-lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed. RESULTS: The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P < 0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P < 0.01). A significant difference in long-lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P < 0.01). No patients showing two or one quadrant with contrast had long-lasting pain relief. CONCLUSIONS: These findings suggest that, when the celiac area is free from anatomic distortions, and the single-needle neurolytic celiac plexus block technique is used, the needle tip should be positioned cephalad to the celiac artery to achieve a wider neurolytic spread. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia.

Adult↗

PubMedDate not supplied

Radiation therapy, bypass operation and celiac plexus block in patients with unresectable locally advanced pancreatic cancer.

BACKGROUND/AIMS: The great majority of pancreatic cancers are unresectable due to local invasion and/or distant metastasis. The treatment options for such patients include bypass operation, celiac plexus block, radiation therapy (RT), chemotherapy and immunotherapy. RT is divided into intraoperative radiation therapy (IORT) and external radiation therapy (ERT). Appropriate palliative treatment remains controversial. METHODOLOGY: Our experience with palliative treatments including bypass operation, celiac plexus block and RT (IORT and ERT) was retrospectively reviewed in 31 Japanese patients with unresectable locally advanced pancreatic cancer. The 31 patients consisted of seven with no RT, six with ERT alone, seven with IORT alone and 11 with both IORT and ERT. Gastrojejunostomy was performed in 25 patients and biliary bypass was done in 29 patients for the therapeutic or prophylactic purpose. RESULTS: No patients developed gastroduodenal obstruction or jaundice until death. Imaging findings after the treatment showed a decrease in tumor size in 11 of the 18 patients examined, an increase in four and no change in the other three. Of 19 patients complaining of back pain before the operation, the pain had disappeared in 12 but persisted in the other seven after the operation. No patients developed back pain after the treatment. Of the 12 patients with pain relief, nine had both RT and celiac plexus block, two RT alone and the other neither RT nor celiac block. Cumulative 0.5-year and 1.0-year survival rates in the group with RT(-), ERT alone, IORT alone IORT and ERT and IORT were 42.9%, 100%, 100%, 100% and 0%, 33.3%, 57.1% and 45.5%, respectively. The survival curve of the RT(-) group was significantly worse than that of the ERT alone group (P = 0.0029), IORT alone group (P = 0.0101) and IORT and ERT group (P = 0.0109). The survival curves of the three RT groups were similar. CONCLUSIONS: RT significantly prolonged survival of patients with unresectable locally advanced pancreatic cancer and combined palliative treatments including bypass operation, celiac plexus block and RT (ERT or IORT) are recommended for such patients.

Aged↗

PubMed1986

Celiac plexus block for interventional radiology.

The effectiveness of regional anesthesia for pain control during biliary manipulations was evaluated. Celiac plexus and/or thoracic epidural blockade was used for 48 procedures in 31 patients. All blockades were administered and patients monitored by anesthesiologists in the radiology department. Thoracic epidural blockade did not alleviate the deep visceral pain associated with biliary manipulations. Celiac plexus blockade in conjunction with local skin anesthesia markedly reduced pain, minimizing the need for intravenously administered narcotics. Two patients experienced transient hypotension during induction of regional anesthesia. There were no other complications. Twelve patients who had previous biliary manipulations with only intravenously administered analgesia reported excellent pain relief with regional anesthesia and expressed a preference for regional anesthesia should another procedure be necessary. The authors conclude that celiac plexus block is a desirable technique of providing analgesia, especially when major biliary interventions are undertaken.

Adult↗

PubMed1995

Celiac plexus blockade in a 7-year-old child with neuroblastoma.

Celiac plexus blockade with ethanol is a widely accepted modality of pain control for adults with cancer pain. The role of interventional strategies in children is less well established. A 7-year-old child with abdominal pain secondary to a Wilms tumor was treated with neurolytic celiac plexus blockade. This resulted in control of abdominal pain for close to three months. This modality is underutilized and should be considered for children with pain due to upper abdominal malignancy.

Adrenal Gland Neoplasms↗