Percutaneous ultrasound long axis (In-plane)-guided approach: A novel technique for celiac plexus neurolysis in patients with advanced pancreatic cancer
Mayank Chansoria1, Sachin Upadhyay2, Bipin Agrawal1, Gautam Das3, Ankita Anand1, Harshita Surange4, Neha Vyas5
1 Department of Anaesthesiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
2 Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
3 Department of Pain Medicine, Daradia Pain Clinic, Kolkata, West Bengal, India
4 Department of Pain, Interventional Pain and Spine Center, New Delhi, India
5 Department of Dentistry, Sparsh Super Speciality Dental Clinic, Jabalpur, Madhya Pradesh, India
Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: The primary objective is to investigate the feasibility of proposed percutaneous ultrasound long axis (LA; in-plane) guided approach for celiac plexus neurolysis (CPN) in patients with advanced pancreatic cancer. The present study also aimed to assess the outcome as well as to document complications specific to the proposed technique if any.
Materials and methods: Celiac plexus neurolysis under LA ultrasound (USG) guidance was performed in thirty one patients (mean age of 58.2 ± 4.7 years) of either-sex (24 men and 7 women) suffering from chronic pain due to pancreatic cancer [visual analog scale (VAS) score > 4] not responding to any pharmacological treatment or in those where opioids-related adverse effects are poorly tolerated. Follow-up was done immediately after injection, first day, 1 week, 4 weeks and 12 weeks following intervention and on an as needed basis thereafter. Post-neurolysis and at each subsequent follow-up visit, pain scores, satisfaction rate and other complications were studied. Level of statistical significance was set at a p < 0.05.
Results: At 12 weeks CPN under LA ultrasound guidance was associated with significant pain relief, reduced NSAIDS/opioids consumption and improved patient satisfaction (p < 0.05). There were no major peri- and/or postoperative complications.
Conclusion: Celiac plexus neurolysis under LA USG guidance enhances effectiveness and was associated with better pain relief, reduced NSAIDS/ opioids consumption and improved patient satisfaction.
Clinical significance: Celiac plexus neurolysis under LA USG guidance enhances effectiveness of pain relief and level of safety in patients with abdominal malignancies.