STEROID AND ALCOHOL CELIAC PLEXUS BLOCK IN CHRONIC-PANCREATITIS

Objective: To evaluate the indications, immediate benefit, patient out come and side effects of either alcohol or steroid coeliac plexus bloc k in a subset of patients with persistent severe pain due to chronic p ancreatitis. Design: We retrospectively analysed 14 patients with pain ful chronic pancreatitis who underwent coeliac plexus block from March 1992 to September 1993. Patients: Patients were ill for a mean of 7 y ears, and were treated for a mean of 3.3 years. Prior surgery was perf ormed in six patients, while 13 underwent prior endoscopic management, all continued to have debilitating pain, and were unresponsive to ora l medication and to appropriate ductal drainage procedures. Methods: A total of 27 coeliac plexus blocks were performed using the posterior approach. Depot steroid (n = 17) or alcohol (n = 10), diluted in local anaesthetic, were injected under fluoroscopic control. Results: Compl ete resolution or significant decrease in pain was recorded after 24 h by all patients. Duration of significant pain relief ranged from 2 da ys to more than 7 months (mean 2 months) after steroid coeliac plexus block, and from 4 days to 14 months (mean 4 months) after alcohol coel iac plexus block. Pain relief lasting at least 1 month was obtained in 56% of steroid and in 70% of alcohol coeliac plexus blocks. In six pa tients, repeating the block produced longer lasting pain relief than a fter the first procedure. Conclusions: Coeliac plexus block is a poten tial component of the therapeutic armamentarium, giving selected chron ic pancreatitis patients with intractable pain a few months of pain-fr ee life.