• The Korean Journal of Pain
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• v.18 no.1
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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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• v.23 no.4
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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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• v.1 no.1
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• pp.28-33
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• 1988

Neurolysis of the celiac plexus has been performed to relieve intractable pain caused by carcinoma of the pancreas, liver, gall bladder or stomach. It is also occasionally effective in controlling the pain of chronic pancreatitis. In practice, however celiac plexus block is not a simple procedure to the beginner. The results and complications are variable. In order to correctly inject neurolytic agents into or near the celiac plexus and to reduce the time consumed to perform celiac plexus block, we used CT scanner for 7 cases of alcohol celiac plexus block. The effects will be described. The purpose of this article is to improve the technical aspect of celiac plexus block to the beginner.

• The Korean Journal of Pain
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• v.34 no.4
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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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• v.28 no.1
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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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• v.7 no.2
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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.

• Journal of Hospice and Palliative Care
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• v.11 no.1
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• pp.51-54
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• 2008

Qualify of life is the main consideration in pain management and palliative care for patients with advanced cancer. Cancer pain is primarily relieved with pharmacological therapy including aretaminophen, nonsteroidal anti-inflammatory drugs, adjuvant analgesics, and opioids. In addition to pharmacological therapy, the neurolytic celiac plexus block is claimed to be an effective approach in management of advanced pancreatic cancer pain. We report our patient who has been treated for advanced cancer pain with multiple neurolytic blocks. The clinical result suggests that combined neurolytic blocks improved the quality of life of patient who had advanced ranter pain by reducing both the intensity of pain and opioid consumption, without serious complications.

• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.56-60
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• 2009

More than 80% of cancer-related pain is pharmacologically controllable, whereas $10{\sim}20%$ of patients require interventional treatments. Neurolytic nerve block can play a major role in cancer pain treatment, and it has been proposed to prevent the development of pain and improve the quality of life of patients with cancer. If the pain is well localized and restricted to certain peripheral parts of the body, spinal peripheral or sympathetic nerve blocks may result in excellent therapeutic effects. Neurolytic sympathetic block, especially Celiac plexsus block (CPB) performed in earlier stages, is effective with successful long term results. However, selection of patients is critical for succeful outcomes. Neurolytic plexus block significantly improves the quality of life of patients and reduces abdominal and pelvic cancer pain, analgesic consumption and adverse opioids-related side effects. Interventional pain management should be considered at earlier stages to provide patients with the best quality of life possible.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.111-114
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• 2006

Pancreatic cancer often elicits intractable abdominal pain which has significant negative impact on the quality of life in patients. Various therapeutic modalities including celiac plexus block are being used to alleviate the pain. The anatomic location of the pancreas often hinders the spread of anesthetic or neurolytic solutions by obliterating the retrocrural space, thus making the classic retrocrural approach unsuccessful. The following case describes a patient with intractable abdominal pain originating from advanced pancreatic cancer, which could be managed successfully with thoracoscopic splanchnicectomy after retrocrural celiac plexus block had failed.

• The Korean Journal of Pain
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• v.35 no.2
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• pp.202-208
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• 2022

Background: Neurolytic celiac plexus block (NCPB) is a typical treatment for severe epigastric cancer pain, but the therapeutic effect is often affected by the variation of local anatomical structures induced by the tumor. Greater and lesser splanchnic nerve neurolysis (SNN) had similar effects to the NCPB, and was recently performed with a paravertebral approach under the image guidance, or with the transdiscal approach under the guidance of computed tomography. This study observed the feasibility and safety of SNN via a transdiscal approach under fluoroscopic guidance. Methods: The follow-up records of 34 patients with epigastric cancer pain who underwent the splanchnic nerve block via the T11-12 transdiscal approach under fluoroscopic guidance were investigated retrospectively. The numerical rating scale (NRS), the patient satisfaction scale (PSS) and quality of life (QOL) of the patient, the dose of morphine consumed, and the occurrence and severity of adverse events were recorded preoperatively and 1 day, 1 week, 1 month, and 2 months after surgery. Results: Compared with the preoperative scores, the NRS scores and daily morphine consumption decreased and the QOL and PSS scores increased at each postoperative time point (P < 0.001). No patients experienced serious complications. Conclusions: SNN via the transdiscal approach under flouroscopic guidance was an effective, safe, and easy operation for epigastric cancer pain, with fewer complications.