An Open Randomized Comparison of Clinical Effectiveness of Protocol-Driven Opioid Analgesia,Celiac Plexus Block or Thoracoscopic Splanchnicectomy for Pain Management in Patients with Pancreatic and Other Abdominal Malignancies |
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| Authors: | C.D. Johnson D.P. Berry S. Harris R.M. Pickering C. Davis S. George C.W. Imrie J.P. Neoptolemos R. Sutton |
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| Affiliation: | 1. Southampton General Hospital, Southampton, Liverpool, UK;2. Leicester General Hospital, Leicester, Liverpool, UK;3. University of Southampton, Southampton, Liverpool, UK;4. Glasgow Royal infirmary, Glasgow, Liverpool, UK;5. Royal Liverpool University Hospital, Liverpool, UK;1. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan;2. Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan;3. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan;4. Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan;5. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan;1. Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota;3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota;4. Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota;6. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota;5. Department of Surgery, Mayo Clinic, Rochester, Minnesota;7. Department of Radiology, Mayo Clinic, Rochester, Minnesota;1. Clinical Research Dr. Tröger, Freiburg, Germany;2. The First Surgical Clinic of the Clinical Centre of Serbia, Belgrade, Serbia;3. Institute for Clinical Research, Berlin, Germany;4. CLINICOBSS, Ni?, Serbia;5. Belgrade School of Medicine, University of Belgrade, Belgrade, Serbia;1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA;2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA;3. Division of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA;4. Lutheran Medical Group, Fort Wayne, Indiana, USA;1. Medical Clinic II, University Hospital Frankfurt, Frankfurt/Main, Germany;2. Klinik für Hämatologie und Onkologie, Märkische Kliniken Lüdenscheid, Lüdenscheid, Germany;3. Department of Oncology and Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany;4. Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt/Main, Germany;5. Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland;6. Onkologische Schwerpunktpraxis, Heidelberg, Germany;7. Medizinische Klinik, Klinikum Nürnberg Nord, Nürnberg, Germany;8. Hämatologie, Onkologie, Klinische Immunologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany;9. Medizinisches Versorgungszentrum Onkologie, Charité – Campus Virchow-Klinikum, Berlin, Germany;10. Onkologische Schwerpunktpraxis, Groß-Gerau, Germany;11. CESAR Central European Society for Anticancer Drug Research–EWIV, Vienna, Austria;12. Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany;13. Department of Nursing and Health, University of Applied Sciences of the Saarland, Saarbruecken, Germany;14. Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany |
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| Abstract: | In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM). Methods: Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB, or MM+TS. Randomization was stratified by treatment centre, tumour type and previous opioid medication. The primary end point was pain relief at 2 months. Results: 65 patients (58 pancreas cancer) were randomized, 18 withdrew or died within 2 months. Effective pain relief was achieved in only one third of subjects at 2 weeks, and just under half at 2 months (MM: 6/19 and 5/12 evaluable patients; CPB: 5/14 and 5/9; TS 4/14 and 4/11). There were no significant differences between the groups in pain scores or opioid consumption, and there was no correlation between continued use of opioids and effective pain relief. Discussion: Previous randomized studies have shown small differences in pain scores, but no difference in opioid consumption and quality of life. The absence of any benefit from interventions in the present study questions their Value. |
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