• The Korean Journal of Pain
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• 제1권2호
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• pp.171-176
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• 1988

It is well known that the celiac plexus block is specially useful for relieve intractable upper abdominal pain caused by upper abdominal visceral malignancy or upper abdominal metastasis from distant organs. But in cases of lower abdominal or pelvic metastasis from upper abdominal malignancy, the lower abdominal intractable pain is remained after the successful celiac plexus block. We have reported 7 cases of celiac plexus block combined with lumbar sympathetic ganglion block, among the 305 cases of the celiac plexus block from 1968 to Nov. 1987, performed in patients with lower abdominal or back pain due to carcinomatosis of lower abdominal metastatic malignancy, that their results were excellent for pain relief.

• The Korean Journal of Pain
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• 제1권1호
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• pp.28-33
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• 1988

1986년 3월 통증치료실을 개설한 이래 상복부의 불인통을 호소하는 12명의 암환자에서 복강신경총 차단을 시행하였다. 처음 5예는 fluoroscopy의 도움만으로, 나머지 7예는 CT를 이용하여 피부에 천자부위를 정하고 재차 수술실로 옮겨서 시행한 결과 다음과 같은 결론을 얻었다. 1) CT를 이용한 복강신경총 차단을 시행할 경우, 평균 시술시간을 훨씬 단축시킬 뿐 아니라(약 1시간) 초보자에게는 시술이 훨씬 용이하다. 2) Fluoroscopy만 이용한 5예 중 3예에서, CT 및 fluoroscopy틀 동시에 이용한 경우는 7예중 5예에서 양호한 결과를 얻었다. 3) 정확한 위치에서 천자하면 신경파괴제의 양을 줄 일 수 있다. 4) 거대 간장, 심한 복수 등에서는 그 효과가 의문시 된다.

• The Korean Journal of Pain
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• 제18권1호
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• pp.74-77
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• 2005

A neurolytic celiac plexus block produces long-lasting pain relief in upper abdominal cancer patients. Unwanted side effects such as local pain, hypotension, and diarrhea are common but the durations of these side effects are usually transient. Chronic diarrhea induced by a neurolytic celiac plexus block is rarely reported and is considered to be an autonomic neuropathy due to sympathetic denervation. A 73-year-old Klatskin tumor patient developed chronic diarrhea after a neurolytic celiac plexus block and the diarrhea was sustained for 3 months despite the use of conventional antidiarrheal treatments. We report a case of chronic diarrhea that was induced by a neurolytic celiac plexus block.

• The Korean Journal of Pain
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• 제28권1호
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• pp.22-31
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• 2015

Background: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. Methods: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. Results: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. Conclusions: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.

• The Korean Journal of Pain
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• 제11권1호
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• pp.130-133
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• 1998

We present our failed case of celiac plexus block using the anterior approach under CT guidance in patient with intolerable abdominal pain originating from pancreatic cancer with celiac invasion. In spite of the proper position of needle, the contrast material was not spread due to the tumoral invasion.

• The Korean Journal of Pain
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• 제34권4호
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• pp.479-486
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• 2021

Background: Prior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain. Methods: A retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB. Results: Among the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB. Conclusions: Celiac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

• The Korean Journal of Pain
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• 제7권2호
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• pp.211-216
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• 1994

Celiac plexus block is performed to relieve intractable upper abdominal cancer pain. Generally, celiac plexus blocks have been performed under control of X-ray fluoroscopy to determine the position of the needle tip and the spread of contrast media. During the period from March 1992 to February 1994, we have performed 21 cases of neurolytic celiac plexus block to alleviate pain of intra-abdominal malignancy. We retrospectively evaluated the location of the needle tip and the spread of contrast media. P-A views of simple abdomen demonstrated the locations of the needle tip: 66.7% of the left needle tips were in upper 3/1 of L1 (6 cases) and $T_{12}-L_1$ interspace (8 cases), 50% of the right needle tips were in upper 1/3 of $L_1$, (6 cases) and $T_{12}-L_1$ interspace (4 cases). Contrast media from the right needle spread upward to middle 1/3 of $T_{10}$ (5 cases) and middle 1/3 of $T_{11}$ (5 cases), downward to middle 1/3 of $L_1$ (6 cases) and lower 1/3 of $L_1$ (3 cases). Contrast media from the left needle were spread upward to middle 1/3 of $T_{10}$ (5 cases) and evenly to other spaces, downward to middle 1/3 of $L_1$, (4 cases) and $L_1-L_2$ interspace (6 cases). We analyze the spread of contrast media according to distance from needle tip by authors score system. Contrast media of right needle spread upward 6.1 and downward 3.4, that of left needle spread upward 6.5 and downward 3.7.

• The Korean Journal of Pain
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• 제14권2호
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• pp.257-260
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• 2001

It is well known that bronchogenic carcinoma frequently metastasize to bony skeleton, although it is unusual for it to metastasize to soft tissue in the form of a musculoskeletal abscess. We report a bronchogenic cancer patient presenting with back pain after undergoing a celiac plexus block. Magnetic resonance imaging (MRI) demonstrated inflammation with an abscess of the paraspinal muscle from T12 to L5; however, it was subsequently diagnosed as a metastatic pleomorphic carcinoma by histopathological study.

• The Korean Journal of Pain
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• 제23권4호
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• pp.274-277
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• 2010

Abdominal pain associated with chronic pancreatitis is often difficult to control with analgesics and can be severely debilitating with significant impairment of quality of life. In these patients, neurolytic celiac plexus block (NCPB) is an effective treatment option with a low complication rate. However, there is a risk of ejaculatory failure after NCPB, which may be a problem in patients with a long life expectancy. We report a case of ejaculatory failure after unilateral NCPB in a patient with chronic pancreatitis.

• The Korean Journal of Pain
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• 제26권4호
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• pp.396-400
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• 2013

Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.