Efficacy and Safety of Celiac Plexus Block in Chronic Pancreatitis: A Multicenter Cohort Study

Celiac plexus block (CPB) is used for pain management in chronic pancreatitis (CP), but real-world evidence is limited. This study evaluated clinical outcomes, safety, and utilization trends of CPB in CP.

We conducted a retrospective cohort study using the TriNetX Research Network. Adults with CP were identified; those with pancreatic malignancy or prior pancreatic surgery were excluded. CP patients who underwent CPB were compared with those without CPB. Propensity score matching (1:1) balanced demographics and comorbidities. Primary outcomes were the prevalence of opioid prescriptions and emergency department (ED) or hospital encounters at 1, 3, 6, and 12 months. Secondary outcomes included 30-day adverse events and utilization trends. Hazard ratios (HRs) with 95% CIs were calculated.

Among 2492 CPB recipients and 138,148 controls, 2443 matched pairs were analyzed. Opioid use was similar at 1 month (HR=0.995; 95% CI: 0.91-1.08) but higher among CPB recipients at 3 months (HR=1.10; 95% CI: 1.02-1.19), 6 months (HR=1.18; 95% CI: 1.10-1.27), and 12 months (HR=1.21; 95% CI: 1.13-1.29). CPB reduced hospital encounters at 1 month (HR: 0.79; 95% CI: 0.71-0.88) and 3 months (HR: 0.90; 95% CI: 0.82-0.98), with no difference thereafter. Adverse events were infrequent: hypotension (1.6%), diarrhea (3.1%). CPB utilization rose 2.4-fold from 2015 to 2024.

While CPB appears to reduce hospital encounters, opioid use increased over long-term follow-up, suggesting that its analgesic effect is short-lived. A randomized controlled trial is underway to determine the true efficacy of CPB in CP.