Assessment of consecutive neurolytic celiac plexus block (NCPB) technique outcomes in the management of refractory visceral cancer pain.

OBJECTIVE: The objective of this study was to assess outcomes and safety of consecutive neurolytic celiac plexus block (NCPB) technique. DESIGN: Retrospective clinical data analysis. SETTING: The study was conducted in three pain departments and academic medical center. PATIENTS: The subject of this study was 12 patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures. INTERVENTIONS: Twelve celiac plexus alcohol neurolytic procedures were performed for pain control after a positive diagnostic block. MATERIALS AND METHODS: Twelve patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures were managed by consecutive NCPB guided by computed tomography at the pain department of Beijing Xuanwu Hospital between January 2005 and June 2010. The present study evaluated the efficacy of consecutive NCPB technique with regard to pain relief, as well as its adverse effects and complications. RESULTS: The efficacy of consecutive NCPB technique with regard to pain relief was observed by a marked decrease in the visual analog score and in opioid consumption, with preprocedural mean values dropping from (8.7±1.0) and (155±56)mg/day of morphine to (1.8±1.1) and (0)mg/day at the first postprocedural visit, respectively. These results persisted during the 6-month follow-up period or until death. Minor adverse effects (moderate diarrhea and mild hypotension) were frequent (N=3, and N=4, respectively), and severe complications occurred in one patient with a transient paraparesis (N=1). No procedure-related mortality was observed. CONCLUSIONS: The consecutive NCPB technique can provide analgesia and the alleviation of the secondary undesirable effects of analgesic drugs resulting from the decrease of morphine consumption in patients with upper abdominal malignancies. In the subject group, the reliability of its analgesic effect is high, with lower rate of severe complications.