[Infiltration block of the coeliac plexus using a plastic catheter]

Area of Science:

• Interventional Pain Management
• Gastrointestinal Oncology
• Neurolytic Procedures

Context:

• Intractable pain is a significant challenge in patients with advanced stomach or pancreatic cancer.
• Conventional analgesic medications often fail to provide adequate relief for severe cancer-related pain.
• The celiac plexus is a key component of the autonomic nervous system involved in visceral pain transmission.

Purpose:

• To evaluate the efficacy and safety of celiac plexus block using Xylocaine followed by alcohol injection for intractable cancer pain.
• To assess the potential of this neurolytic technique in improving quality of life for patients with advanced abdominal malignancies.

Summary:

• Nine patients with intractable stomach or pancreatic cancer pain underwent a two-stage celiac plexus block.
• Initially, 25 ml of Xylocaine (0.5-0.8%) was administered via catheters under x-ray guidance, followed by 25 ml of 50% alcohol the next day.
• Eight patients experienced complete pain cessation, and one patient reported 50% improvement. Minor adverse events included post-dural puncture headache, mild Xylocaine toxicity, and transient hypotension.

Impact:

• This study highlights the effectiveness of celiac plexus neurolysis as a minimally invasive option for managing severe cancer pain.
• The procedure offers significant pain relief, potentially reducing opioid reliance and improving patient outcomes.
• Further research may explore optimizing the timing and agents used in celiac plexus blocks for enhanced efficacy and safety.