CT-guided Celiac Plexus Neurolysis in the Management of Severe Upper Abdominal Pain

Abstract

Abdominal pain is a significant problem in patients with malignant tumors of the abdominal cavity, which dramatically affects the quality of life and survival. Chronic pain is experienced by about half of all cancer patients and more than 70  % in the late stages of the disease, the prevalence is even higher in patients with pancreatic cancer. Usually, pain management in a given cohort of patients is a very difficult issue, often requiring the chronic use of high doses of narcotic and non-narcotic analgesics or a combination thereof. Opioids are more effective, relieve pain, but have several side effects, causing nausea and vomiting, constipation, itching, dry mouth, severe sedation or delusions, hallucinogenic effects, the need to increase the dose as tolerance develops, and also intolerance to drugs. Inadequate pain management not only negatively impacts the quality of life but also correlates with poorer clinical survival rates for patients.

The work deals with the anatomy of the celiac plexus (CP), features of innervation, comparison of different techniques of CP neurolysis, practical aspects of performing, indications and contraindications, possible complications, as well as recommendations for the successful conduct of CT-guided sympatholysis.

Sympatholysis is a safe and effective way of treating severe pain in patients with malignant neoplasms of the upper half of the abdominal cavity. CP neurolysis should be used as one of the key techniques for a multidisciplinary approach to treatment, which provides significant relief of the pain syndrome intensity, reduces the use of opioid drugs and, thus, their side effects. A thorough understanding of the various methods and techniques allows the interventionist to optimize the approach for each patient and thus successfully carry out sympatholysis while minimizing complications.