Computed Tomography-Guided Versus Fluoroscopy-Guided Celiac Plexus Neurolysis for Pancreatic Cancer Pain: A Novel...

The aim of this study was to evaluate and compare the efficacy, safety, opioid-sparing effect and functional outcomes of computed tomography (CT)-guided versus fluoroscopy-guided celiac plexus neurolysis (CPN) in managing pancreatic cancer pain. The study integrates pain phenotyping using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale to assess response in neuropathic subtypes.

This was an ambispective observational study conducted at King George's Medical University, encompassing a retrospective cohort (January 2020-December 2022) and a prospective cohort (January 2023-December 2024). Sixty patients with histologically confirmed pancreatic adenocarcinoma and baseline pain scores of ≥7 on the visual analogue scale (VAS) were included. Patients underwent bilateral posterior retrocrural CPN under either CT (n = 30) or fluoroscopic (n = 30) guidance. Neurolysis was achieved using absolute alcohol (6-10 mL) mixed with 2% lignocaine (2-3 mL). Pain scores (VAS and LANSS), opioid use (in morphine equivalents) and functional outcomes (karnofsky performance status [KPS] and short form 36 health survey questionnaire [SF-36]) were recorded at baseline, immediate post-procedure, 1 week, 1 month and 3 months. Complication rates and opioid dose reduction were also evaluated. Statistical analysis was conducted using the Statistical Package for the Social Sciences v26.0 with a significance threshold of P < 0.05.

Both groups were comparable at baseline in terms of age, sex and initial pain scores. The mean VAS decreased from 8.9 ± 1.2 to 5.4 ± 2.1 in the CT group and from 8.8 ± 1.1 to 5.8 ± 2.3 in the fluoroscopy group at 3 months (P = 0.042). LANSS scores showed greater improvement in the CT group (baseline 13.8 ± 1.4-8.2 ± 2.1) compared to the fluoroscopy group (13.6 ± 1.5-9.5 ± 2.3; P = 0.038). Opioid dose reduction of ≥30% was observed in 66.7% (CT) versus 60.0% (fluoro). Functional improvement, assessed by KPS, was greater in the CT group (+15 points) than in the fluoroscopy group (+12 points). Complications were significantly lower in the CT group (20%) compared to the fluoroscopy group (46.7%, P = 0.019), with diarrhoea and hypotension being the most common.

Both CT and fluoroscopy-guided CPN provide effective pain relief in pancreatic cancer. However, CT-guided CPN is associated with significantly greater pain reduction, especially in patients with neuropathic pain features, lower complication rates and better functional outcomes. Pain phenotyping using LANSS enhances procedural decision-making and supports a personalised approach to palliative care in pancreatic malignancy.