Assessment of Celiac Plexus Block and Neurolysis Outcomes and Technique in the Management of Refractory Visceral Cancer Pain

作者：Erdek Michael A^*; Halpert Daniel E; Fernandez Marlis Gonzalez; Cohen Steven P

来源：Pain Medicine, 2010, 11(1): 92-100.

• Cancer Pain
• Nerve Block
• Sympathetic Block
• Outcome Assessment

Objective. To assess demographic and clinical factors associated with celiac plexus neurolysis outcomes.
Design. Retrospective clinical data analysis.
Setting. A tertiary care, academic medical center.
Patients. Forty-four patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures.
Interventions. Fifty celiac plexus alcohol neurolytic procedures done for pain control after a positive diagnostic block.
Outcome Measures. A successful treatment was predefined as >50% pain relief sustained for >= 1 month. The following variables were analyzed for their association with treatment outcome: age, gender, duration of pain, origin of tumor, opioid dose, type of radiological guidance used, single- vs double-needle approach, type of block (e. g., antero- vs retrocrural), immediate vs delayed neurolysis, volume of local anesthetic employed for both diagnostic and neurolytic blocks, and use of sedation.
Results. Those variables correlated with a positive outcome included lower opioid dose and the absence of sedation. Strong trends for a positive association with outcome were found for the use of computed tomography (vs fluoroscopy), and using <20 mL of local anesthetic for the diagnostic block.
Conclusions. Celiac plexus neurolysis may provide intermediate pain relief to a significant percentage of cancer sufferers. Both careful selection of candidates based on clinical variables, and technical factors aimed at enhancing the specificity of blocks may lead to improved outcomes.

• 出版日期2010-1