Celiac Plexus Block and end of life care, Dr. Chon

 Chang-Ho Chon, DO

Article:
Effect of Neurolytic Celiac Plexus Block on Pain Relief, Quality of Life, and Survival in Patients with Unresectable Pancreatic Cancer

Wong, Gilbert Y., et al. JAMA. Mar 3, 2004 – Vol 291 – No. 2, pp 1092-9

Summary:

Pancreatic cancer is an aggressive malignancy associated with high mortality and often severe upper abdominal pain. Previous studies by Lillemoe, et al. and Kelsen, et al. suggested pancreatic cancer patients to have decreased pain following intraoperative chemical splanchnicectomy and decreased survival when pain was out of control, respectively. This double-blinded, randomized control trial, which was conducted at Mayo Clinic, aimed to test the hypothesis that neurolytic celiac plexus block (NCPB) vs opioids alone can improve pain relief, quality of life (QOL), and survival in patients with unresectable pancreatic cancer.

100 eligible patients were enrolled and randomly assigned to receive either NCPB or systemic analgesic therapy (SAT) with a sham injection. All patients were allowed to receive additional opioids managed by a clinician blinded to the treatment assignment.

At week 1, the mean pain intensity decreased for each group from baseline, but the pain relief was much greater in the NCPB group (53% vs 27%, P=0.005). After week 1, pain intensity decreased gradually and was significantly lower for NCPB than for SAT (P=0.01). Opioid consumption increased over time with no evidence of difference between the groups. Following week 1, QOL gradually declined and did not differ between groups (P=0.46). At 1 year, 16% of NCPB patients and 6% of SAT patients were alive, but survival did not differ significantly (P=0.26).

The study concludes, then, that although NCPB improves pain in this patient population, it does not affect QOL or survival.