Assessment of celiac plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain

Objective: To assess demographic and clinical factors associated with celiac plexus neurolysis outcomes. Design: Retrospective clinical data analysis. Setting: A tertiary care, academic medical center. Patients: Forty-four patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures. Interventions: Fifty celiac plexus alcohol neurolytic procedures done for pain control after a positive diagnostic block. Outcome Measures: A successful treatment was predefined as >50% pain relief sustained for ≥1 month. The following variables were analyzed for their association with treatment outcome: age, gender, duration of pain, origin of tumor, opioid dose, type of radiological guidance used, single- vs double-needle approach, type of block (e.g., antero- vs retrocrural), immediate vs delayed neurolysis, volume of local anesthetic employed for both diagnostic and neurolytic blocks, and use of sedation. Results: Those variables correlated with a positive outcome included lower opioid dose and the absence of sedation. Strong trends for a positive association with outcome were found for the use of computed tomography (vs fluoroscopy), and using <20 mL of local anesthetic for the diagnostic block. Conclusions: Celiac plexus neurolysis may provide intermediate pain relief to a significant percentage of cancer sufferers. Both careful selection of candidates based on clinical variables, and technical factors aimed at enhancing the specificity of blocks may lead to improved outcomes.