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Pain Outcomes After Celiac Plexus Block in Children and Young Adults with Cancer
Doralina L Anghelescu1, Andy Guo1, Kyle J Morgan1
1Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Celiac plexus block (CPB) shows potential in managing abdominal pain in pediatric cancer patients. This study found CPB reduced pain scores and opioid use in young patients, though often applied late in disease progression.
Area of Science:
- Pain Management
- Pediatric Oncology
- Interventional Pain Medicine
Background:
- Celiac plexus block (CPB) is established for adult abdominal pain.
- Pediatric literature on CPB efficacy is scarce, limited to case reports.
- Abdominal malignancies in children and young adults present significant pain management challenges.
Purpose of the Study:
- To evaluate the effectiveness of celiac plexus block (CPB) in managing abdominal pain.
- To assess pain scores and opioid consumption in pediatric and young adult patients with cancer.
- To explore the utility of CPB in a younger demographic with advanced abdominal malignancies.
Main Methods:
- Retrospective evaluation of four pediatric and young adult patients (aged 8-20 years) with abdominal malignancies.
- Assessment of pain outcomes using daily pain scores (PS, 0-10) and morphine consumption (MED, mg/kg/day).
- Comparison of PS and MED before and after the celiac plexus block procedure.
Main Results:
- All patients experienced a reduction in mean daily pain scores post-CPB.
- One patient achieved sustained pain reduction and discontinued analgesics for 6 months.
- Opioid consumption varied; some patients required increased MED due to disease progression, while others showed initial reduction.
Conclusions:
- Celiac plexus block (CPB) may be a viable option for reducing pain and opioid requirements in pediatric cancer patients.
- CPB demonstrated effectiveness in improving pain scores, even in patients with limited survival.
- The study highlights the late application of CPB in the disease trajectory, suggesting potential for earlier intervention.
Abstract:
The use of celiac plexus block (CPB) for abdominal pain has been extensively reported in adults. However, pediatric literature is limited to three single case reports and a series of three cases. This study evaluated the effectiveness of CPB in children and young adults (aged 8-20 years) with abdominal malignancies. Pain outcomes after CPB were evaluated in four children and young adults with cancer. Mean daily pain score (PS, 0-10) and morphine consumption (intravenous morphine equivalent daily [MED], mg/kg/day) before and after CPB were used to assess effectiveness. Mean daily PS reduced after CPB in all patients. In one patient, this reduction was sustained up to 6 months of follow-up, and analgesics were discontinued 1 week after CPB. The other three patients had limited survival (6, 16, and 37 days) after CPB. One patient had a PS of 0 over the last few days of life, but the MED was escalated from 0.74 before the block to 5.4 mg/kg/day at the end of life. In the other two patients, MED was lower during the first week after CPB than that before CPB (4.55 vs. 1.59 and 2.88 vs. 1.51 mg/kg/day, respectively). As these two patients had disease progression during their last days of life, the MED was increased to 4.75 and 263.9 mg/kg/day, respectively. Our results suggest that CPB may contribute to reducing PS and MED. We observed the use of CPB rather late in the disease trajectory.
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