The use of different methods of celiac plexus neurolysis in the treatment of pain syndrome associated with pancreatic cancer
DOI:
https://doi.org/10.25305/unj.257987Keywords:
neurolysis, sympatholysis, celiac plexus, solar plexus, pancreatic cancer, abdominal pain, pain management, endoscopic ultrasoundAbstract
Черевне сплетення є визнаною мішенню для інтервенційних методик лікування болю, що виникає внаслідок неоперабельного злоякісного новоутворення підшлункової залози або інших органів, розташованих у верхній половині черевної порожнини.
Представлено клінічний випадок пацієнтки, 66 років, з раком підшлункової залози, якій для зменшення больового синдрому здійснено декілька спроб застосувати методики нейролізису сонячного сплетення. У зв’язку з великим розміром пухлини та її проростанням у навколишні органи провести симпатолізис під час біопсії за допомогою ендоскопічної ультрасонографії було неможливо. Спроба нейролізису переднім трансабдомінальним доступом під ультразвуковою навігацією не дала бажаного результату. Задній крізьшкірно-паравертебральний підхід під комп’ютерно-томографічним контролем сприяв значному полегшенню стану пацієнтки.
Проведено порівняння різних методик нейролізису сонячного сплетення, їхніх переваг та недоліків використання в закладах охорони здоров’я України.
The celiac plexus is a recognized target for interventions to provide pain relief to patients with pain resulting from inoperable malignancies of the pancreas or other organs in the upper abdomen.
The clinical case of a 66-year-old female patient with pancreatic cancer who underwent several different techniques of celiac plexus neurolysis to reduce pain is presented. Due to the large size of the tumor and its extension into adjacent organs, it was not possible to perform sympatholysis during the biopsy using endoscopic ultrasonography. An attempt of neurolysis through an anterior transabdominal US-guided approach did not bring the desired result. Posterior percutaneous paravertebral CT-guided approach provided a significant relief of the patient's condition.
Comparisons of different methods of the celiac plexus neurolysis and their advantages and disadvantages of use in health care institutions of Ukraine are given.
If it is impossible to perform neurolysis with the help of endosonography, anterior transabdominal US-guided approach, or if there are difficulties in performing them, we recommend performing neurolysis by posterior percutaneous-paravertebral CT-guided approach.
References
Zacharias NA, Karri J, Garcia C, Lachman LK, Abd-Elsayed A. Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article. Pain Ther. 2021 Jun;10(1):115-141. doi: 10.1007/s40122-020-00227-8
Kurita GP, Sjøgren P, Klepstad P, Mercadante S. Interventional Techniques to Management of Cancer-Related Pain: Clinical and Critical Aspects. Cancers (Basel). 2019 Mar 29;11(4):443. doi: 10.3390/cancers11040443
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7-30. doi: 10.3322/caac.21387
Dobosz Ł, Kaczor M, Stefaniak TJ. Pain in pancreatic cancer: review of medical and surgical remedies. ANZ J Surg. 2016;86(10):756-761. doi: 10.1111/ans.13609
Bhatnagar S, Joshi S, Rana SP, Mishra S, Garg R, Ahmed SM. Bedside ultrasound-guided celiac plexus neurolysis in upper abdominal cancer patients: a randomized, prospective study for comparison of percutaneous bilateral paramedian vs. unilateral paramedian needle-insertion technique. Pain Pract. 2014;14(2):E63-E68. doi: 10.1111/papr.12107
Shoshiashvili V, Japharidze N, Shoshiashvili I, Rukhadze T. Computed Tomography Guided Transdiscal Splanchnic Nerve Block for Cancer Pain Treatment. J Anesth Clin Res. 2020;11:964. doi: 10.35248/2155-6148.20.11.964
Eroshkin AA, Romanukha DM. CT-Guided Celiac Plexus Neurolysis in the Management of Severe Upper Abdominal Pain. Ukrainian Neurosurgical Journal. 2020;26(2):34-45. doi: 10.25305/unj.201779
Masuda T, Kuramoto M, Shimada S, et al. Splanchnicectomy for pancreatic cancer pain. Biomed Res Int. 2014;2014:941726. doi: 10.1155/2014/941726
Asif AA, Walayat SK, Bechtold ML, Revanur V, Puli SR. EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients - a meta-analysis and systematic review. J Community Hosp Intern Med Perspect. 2021;11(4):536-542. Published 2021 Jun 21. doi: 10.1080/20009666.2021.1929049
Cornman-Homonoff J, Holzwanger DJ, Lee KS, Madoff DC, Li D. Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain. Semin Intervent Radiol. 2017;34(4):376-386. doi: 10.1055/s-0037-1608861
Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol. 1999;94(4):900-905. doi: 10.1111/j.1572-0241.1999.01042.x
Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, de la Mora JG, Gleeson FC, Pearson RK, Pelaez MC, Petersen BT, Vege SS, Chari ST. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol. 2008 Jan;103(1):98-103. doi: 10.1111/j.1572-0241.2007.01607.x
Nagels W, Pease N, Bekkering G, Cools F, Dobbels P. Celiac plexus neurolysis for abdominal cancer pain: a systematic review. Pain Med. 2013 Aug;14(8):1140-63. doi: 10.1111/pme.12176
Titton RL, Lucey BC, Gervais DA, Boland GW, Mueller PR. Celiac plexus block: a palliative tool underused by radiologists. AJR Am J Roentgenol. 2002 Sep;179(3):633-6. doi: 10.2214/ajr.179.3.1790633
Davies DD. Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med. 1993 May;86(5):264-6.
Kambadakone A, Thabet A, Gervais DA, Mueller PR, Arellano RS. CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics. 2011 Oct;31(6):1599-621. doi: 10.1148/rg.316115526
McAninch SA, Raizada MS, Kelly SM. Pulmonary embolism following celiac plexus block and neurolysis. Proc (Bayl Univ Med Cent). 2016 Jul;29(3):329-30. doi: 10.1080/08998280.2016.11929458
Dumitrescu A, Aggarwal A, Chye R. A retrospective case series of patients who have undergone coeliac plexus blocks for the purpose of alleviating pain due to intra-abdominal malignancy. Cancer Rep (Hoboken). 2020;3(5):e1265. doi: 10.1002/cnr2.1265
Jin G, Qiu X, Ding M, Dai M, Zhang X. Navigated magnetic resonance imaging-guided celiac plexus neurolysis using an open magnetic resonance system for pancreatic cancer patients with upper abdominal pain. J Cancer Res Ther. 2019;15(4):825-830. doi: 10.4103/jcrt.JCRT_38_19
Choi EJ, Choi YM, Jang EJ, Kim JY, Kim TK, Kim KH. Neural Ablation and Regeneration in Pain Practice. Korean J Pain. 2016 Jan;29(1):3-11. doi: 10.3344/kjp.2016.29.1.3
Wyse JM, Chen YI, Sahai AV. Celiac plexus neurolysis in the management of unresectable pancreatic cancer: when and how? World J Gastroenterol. 2014 Mar 7;20(9):2186-92. doi: 10.3748/wjg.v20.i9.2186
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