Percutaneous Ultrasound Long Axis (In-plane)-guided Approach: A Novel Technique for Celiac Plexus Neurolysis in Patients with Advanced Pancreatic Cancer

JOURNAL TITLE: Journal on Recent Advances in Pain

Author
1. Mayank Chansoria
2. Neha Vyas
3. Harshita Surange
4. Gautam Das
5. Sachin Upadhyay
6. Bipin Agrawal
7. Ankita Anand
ISSN
2454-6607
DOI
10.5005/jp-journals-10046-0142
Volume
5
Issue
2
Publishing Year
2019
Pages
7
Author Affiliations
    1. Department of Orthopedic, Traumatology and Rehabilitation, N.S.C.B Medical College Jabalpur, Madhya Pradesh, India, Shalby Hospital, Jabalpur, Madhya Pradesh, India
    1. Department of Anaesthesiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
    1. Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
    2. Ramrikdas Haralalka Hospital and Bangur Institute of Neuroscience, Kolkata, West Bengal, India
    1. Department of Anaesthesiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
    1. Department of Radiology, Diagnostic and Imaging Centre New Delhi, India
  • Article keywords
    Celiac plexus, Celiac plexus neurolysis, Long axis ultrasound, Pancreatic cancer, Visual analog scale

    Abstract

    Introduction: The primary objective is to investigate the feasibility of proposed percutaneous ultrasound long axis (LA; in-plane) guided approach for celiac plexus neurolysis (CPN) in patients with advanced pancreatic cancer. The present study also aimed to assess the outcome as well as to document complications specific to the proposed technique if any. Materials and methods: Celiac plexus neurolysis under LA ultrasound (USG) guidance was performed in thirty one patients (mean age of 58.2 ± 4.7 years) of either-sex (24 men and 7 women) suffering from chronic pain due to pancreatic cancer [visual analog scale (VAS) score > 4] not responding to any pharmacological treatment or in those where opioids-related adverse effects are poorly tolerated. Follow-up was done immediately after injection, first day, 1 week, 4 weeks and 12 weeks following intervention and on an as needed basis thereafter. Post-neurolysis and at each subsequent follow-up visit, pain scores, satisfaction rate and other complications were studied. Level of statistical significance was set at a p < 0.05. Results: At 12 weeks CPN under LA ultrasound guidance was associated with significant pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction (p < 0.05). There were no major peri- and/or postoperative complications. Conclusion: Celiac plexus neurolysis under LA USG guidance enhances effectiveness and was associated with better pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction. Clinical significance: Celiac plexus neurolysis under LA USG guidance enhances effectiveness of pain relief and level of safety in patients with abdominal malignancies.

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