Effect of Celiac Plexus Neurolysis for Pain Relief in Patients with Upper Abdominal Malignancy: A Retrospective Observational Study and Review of Literature.

BACKGROUND: 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 or non-responsive to the pharmacological management, hence minimal invasive pain intervention like celiac plexus neurolysis or splanchnic nerve rhizolysis may be required to relieve pain of such patients. OBJECTIVE: The aim of this retrospective study is to assess the effect of celiac plexus neurolysis for pain relief in patients with upper gastro-intestinal malignancies. STUDY DESIGN: This is a retrospective, observational study with short review. METHODS: This retrospective observational study was done in the Pain Medicine unit from 2016 and November 2018. Ninety-four patients with upper abdominal malignancy and unrelenting pain, non-responsive or poorly responsive to pharmacological treatment as per WHO ladder of analgesics, received fluoroscopy-guided celiac plexus neurolysis (CPN). All the patients underwent celiac plexus neurolysis through Trans-Aortic approach and the primary outcome measure was pain as assessed with Visual Analogue Scale (VAS) ranging from 0 to 10; the secondary outcome measures were morphine consumption per day (M), quality of life (QOL) as assessed by comparing the percent of positive responses and complications, if any. These were noted and analyzed prior to intervention and then on day 1, and months 1, 2, 3, 4, 5, 6 following CPN. RESULTS: Follow up was completed 6 months after the procedure. VAS score, daily morphine consumption, and the quality of life showed improvement for the duration of the study. There was some relapse in pain and deterioration in QOL during the fourth to sixth month of pain intervention due to disease progression. Some transient known side effects also occurred. CONCLUSION: Trans-Aortic celiac plexus neurolysis with low volume of alcohol is a safe procedure providing up to 6 months of pain relief and is an effective, well established, minimally invasive procedure for abdominal pain due to primary malignancy or metastatic spread.

Management of Postoperative Discitis: A Review of 31 Patients.

BACKGROUND: The aim of the study was to retrospectively evaluate the outcome of medical management of postoperative discitis (POD). MATERIALS AND METHODS: A total of 31 patients treated for POD were included in the study. Clinical, radiological, and laboratory data of all patients were collected and evaluated. All patients were treated initially with bed rest and antibiotic therapy after radiological diagnosis. Surgical management was undertaken after failure of 4 weeks of conservative management. All cases were followed clinically with laboratory and radiological investigations. RESULTS: Five cases failed to respond to medical management and were treated surgically with debridement and transpedicular fixation. All patients showed clinical recovery till the last follow-up. CONCLUSION: Early diagnosis and proper management are the keys to successful outcome of postoperative spndylodiscitis. Surgical debridement and fusion are required when conservative treatment fails.