Computed tomography-guided celiac plexus neurolysis for intractable pain of unresectable pancreatic cancer

Aim of this study

To appraise the value of CT-guided celiac plexus neurolysis (CPN) as an effective method for alleviating intractable pain in patients with unresectable pancreatic cancer.

Patients and methods

22 patients (their ages ranged between 45 and 73 years) with severe pain due to unresectable pancreatic cancer were subjected to CT-guided CPN by 25–30 mL of 97% ethanol via anterior approach and single puncture technique. The pain intensity scoring, both before and after the procedure, was done using the Visual Analogue Scale (VAS).

Results

All patients showed a significant pain reduction after CPN (P < 0.001), with peak reduction in the first day after CPN. Also, the mean ranks of analgesic requirements showed significant reduction (P < 0.001) and this reduction in analgesic requirements was maintained up to 3 months after the CPN. Less than half of the study population (45.5%) had some post-procedural adverse events, which were minimal and transient.

Conclusion

The CT-guided CPN via using anterior median approach and single puncture technique with injection of 25–30 mL of 97% of ethanol is an ideal palliative treatment for controlling severe pain caused by unresectable pancreatic cancer, with a significant reduction in the analgesic requirements.