Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Celiac Plexus Neurolysis for the Treatment of Patients with Terminal Cancer at a Tertiary University Hospital in Korea

  • Byeon, Gyeong-Jo (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Park, Ju Yeon (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Choi, Yun-Mi (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Ri, Hyun-Su (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Yoon, Ji-Uk (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Choi, Eun-Ji (Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital)
  • Received : 2019.04.26
  • Accepted : 2019.10.24
  • Published : 2020.03.01
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Abstract

Purpose: The aim of this study was to investigate celiac plexus neurolysis (CPN) for the treatment of cancerous upper abdominal pain in a tertiary university hospital in Korea. Methods: At the tertiary university hospital in Korea, electronic medical records of cancer patients who underwent CPN and died in the hospital from November 2009 to June 2018 were retrospectively analyzed. Results: The total number of subjects was 51. The 17 patients were from the Department of Gastroenterology (33.0%), followed by 11 patients from the Department of Hemato-oncology (21.6%), 11 patients from the Department of Anesthesia and Pain Medicine (21.6%), 9 patients from the Department of General Surgery (17.6%). The diagnosis was pancreatic cancer in 15 patients (29.4%), stomach cancer in 8 patients (15.7%), hepatobiliary cancer in 20 patients (39.2%), colon cancer in 1 patient (2.0%), esophageal cancer in 2 patient (3.9%) and intra-abdominal metastasis in 5 patients (9.8%). The mean survival time after the surgery was 66.4±55.0 days. The pain intensity before and 1 week after the procedure significantly decreased, but the amounts of opioids consumed before and 1 week after the procedure were not statistically significant. Side effects occurred after the procedure including temporary localized pain in 24 patients (47.0%), hypotension in 12 (23.5%), and diarrhea in 6 (11.8%). Conclusion: CPN is an effective and safe procedure for reducing upper abdominal pain caused by cancer, and it is necessary to perform CPN within the appropriate time by establishing a system of interdepartmental cooperation.

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References

  1. Bowles MJ, Benjamin IS. ABC of the upper gastrointestinal tract: Cancer of the stomach and pancreas. BMJ 2001;323:1413-6. https://doi.org/10.1136/bmj.323.7326.1413
  2. Azevedo Sao Leao Ferreira K, Kimura M, Jacobsen Teixeira M. The WHO analgesic ladder for cancer pain control, twenty years of use. How much pain relief does one get from using it? Support Care Cancer 2006;14:1086-93. https://doi.org/10.1007/s00520-006-0086-x
  3. Portenoy RK. Treatment of cancer pain. Lancet 2011;377:2236-47. https://doi.org/10.1016/S0140-6736(11)60236-5
  4. Seo MS, Shim JY. Breakthrough cancer pain. Korean J Hosp Palliat Care 2015;18: 1-8. https://doi.org/10.14475/kjhpc.2015.18.1.1
  5. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician 2008;11(2 Suppl):S105-20.
  6. de Oliveira R, dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain 2004;110:400-8. https://doi.org/10.1016/j.pain.2004.04.023
  7. Nagels W, Pease N, Bekkering G, Cools F, Dobbels P. Celiac plexus neurolysis for abdominal cancer pain: a systematic review. Pain Med 2013;14:1140-63. https://doi.org/10.1111/pme.12176
  8. Wong GY, Schroeder DR, Carns PE, Wilson JL, Martin DP, Kinney MO, et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 2004;291:1092-9. https://doi.org/10.1001/jama.291.9.1092
  9. Fujii-Lau LL, Bamlet WR, Eldrige JS, Chari ST, Gleeson FC, Abu Dayyeh BK, et al. Impact of celiac neurolysis on survival in patients with pancreatic cancer. Gastrointest Endosc 2015;82:46,56.e2. https://doi.org/10.1016/j.gie.2014.12.036
  10. Oh TK, Lee WJ, Woo SM, Kim NW, Yim J, Kim DH. Impact of celiac plexus neurolysis on survival in patients with unresectable pancreatic cancer: A retrospective, propensity score matching analysis. Pain Physician 2017;20:E357-65.
  11. Berdine HJ, Nesbit SA. Equianalgesic dosing of opioids. J Pain Palliat Care Pharmacother 2006;20:79-84. https://doi.org/10.1080/J354v20n04_16
  12. Shaheen PE, Walsh D, Lasheen W, Davis MP, Lagman RL. Opioid equianalgesic tables: are they all equally dangerous? J Pain Symptom Manage 2009;38:409-17. https://doi.org/10.1016/j.jpainsymman.2009.06.004
  13. National Cancer Institute (U.S.). Common terminology criteria for adverse events (CTCAE) v 4.03. [Bethesda, Md.]:U.S. Department of Health and Human Services;2010.
  14. Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 1995;80:290-5. https://doi.org/10.1213/00000539-199502000-00015
  15. Koyyalagunta D, Engle MP, Yu J, Feng L, Novy DM. The effectiveness of alcohol versus phenol based splanchnic nerve neurolysis for the treatment of intra-abdominal cancer pain. Pain Physician 2016;19:281-92. https://doi.org/10.36076/ppj/2019.19.281
  16. Wang PJ, Shang MY, Qian Z, Shao CW, Wang JH, Zhao XH. CT-guided percutaneous neurolytic celiac plexus block technique. Abdom Imaging 2006;31:710-8. https://doi.org/10.1007/s00261-006-9153-5
  17. Dobosz L, Stefaniak T, Dobrzycka M, Wieczorek J, Franczak P, Ptaszynska D, et al. Invasive treatment of pain associated with pancreatic cancer on different levels of WHO analgesic ladder. BMC Surg 2016;16:20. https://doi.org/10.1186/s12893-016-0136-3
  18. Kong YG, Shin JW, Leem JG, Suh JH. Computed Tomography (CT) simulated fluoroscopy-guided transdiscal approach in transcrural celiac plexus block. Korean J Pain 2013;26:396-400. https://doi.org/10.3344/kjp.2013.26.4.396
  19. Ina H, Kitoh T, Kobayashi M, Imai S, Ofusa Y, Goto H. New technique for the neurolytic celiac plexus block: the transintervertebral disc approach. Anesthesiology 1996;85:212-7. https://doi.org/10.1097/00000542-199607000-00028
  20. Erdine S. Celiac ganglion block. Agri 2005;17:14-22.