Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer

Objective: To compare pain relief in metastatic pancreatic cancer patients between neurolytic celiac plexus block (NCPB) and epidural 5% butamben susp ension (EBS), a material-based delivery system of a local anesthetic that p roduces a long-lasting differential nerve block. Design: Open-label patient-selected parallel groups. Setting: Urban tertiary care medical center. Patients: Twenty-four adult patients with metastatic pancreatic cancer expe riencing pain uncontrolled by systemic opioids who were referred to a multi disciplinary pain clinic for interventional therapy. Interventions: Antecrural NCPB-block with ethanol and epidural 5% butamben suspension injections. Measures: Subjective global pain relief assessments on a 0-100% scale were made weekly for 4 weeks and then monthly. Change in opioid use postinterven tion. Results: Eight patients had a single NCPB and three patients had two NCPB. Four of the former and two of the latter had successful pain relief defined to be a more than 75% reduction in pain when compared with pretreatment ma intained for more than 4 weeks or until death (if less than 4 weeks). Thirt een patients received EBS in divided doses. Eleven patients received a cumu lative EBS dose of 5 grams, one patient received a cumulative EBS dose of 2 .5 grams, and one patient received a cumulative EBS dose of 8.75 grams. Nin e of the eleven patients and each of the other two patients had successful pain relief. The overall incidence (85% EBS vs. 55% NCPB), the duration of successful pain relief, and the percent reduction in opioid use did not dif fer between the two groups. There were no serious complications. Conclusion: EBS appears to be a safe and effective alternative to NCPB in t he treatment of pancreatic cancer pain.