3 POSTERIOR PERCUTANEOUS CELIAC PLEXUS BLOCK TECHNIQUES - A PROSPECTIVE, RANDOMIZED STUDY IN 61 PATIENTS WITH PANCREATIC-CANCER PAIN

Variations and refinements of the classic retrocrural technique of neu rolytic celiac plexus block (NCPB) for pancreatic cancer pain (PCP) ha ve been proposed over the last 30 yr to improve success rates, avoid c omplications and enhance diagnostic accuracy. The aim of this prospect ive, randomized study was to assess the efficacy and morbidity of thre e posterior percutaneous NCPB techniques in 61 patients with PCP. The 61 patients were randomly allocated to three NCPB treatment groups: gr oup 1 (20 patients, transaortic plexus block); group 2 (20 patients, c lassic retrocrural block); and group 3 (21 patients, bilateral chemica l splanchnicectomy). The quality and quantity of pain were analyzed be fore and after NCPB. No statistically significant differences (P > 0.0 5) were found among the three techniques in terms of either immediate or up-to-death results. Operative mortality was nil with the three tec hniques and morbidity negligible. NCPB abolished celiac PCP in 70-80% of patients immediately after the block and in 60-75% until death. Bec ause celiac pain was only a component of PCP in all patients, especial ly in those with a longer time course until death: 1) abolition of suc h pain did not ensure high percentages of complete pain relief (immedi ate pain relief in 40-52%; pain relief until death in 10-24%); 2) NCPB was effective in controlling PCP in a higher percentage of cases if p erformed early after pain onset, when the pain was still only or mainl y of celiac type and responded well to nonsteroidal antiinflammatory d rug therapy; and 3) the probability of patients remaining completely p ain-free diminished with increased survival time. NCPB alone is unable to ensure complete relief of PCP until death, but, by abolishing the visceral pain component, substantial benefit in the treatment of such pain in most cases is achieved.