Has the analgesic efficacy of neurolytic celiac plexus block been demonstrated in pancreatic cancer pain?
Cancer of the pancreas is rising in incidence and will strike 27,000 Americans this year. There is no curative therapy for most patients, so palliation of symptoms should be the prime concern. Severe pain is very common, and often difficult to treat. Neurolytic celiac plexus block (NCPB) is claimed by some to be the most effective way to treat pancreatic cancer pain (PCP), yet only a minority of patients undergo this procedure. We have reviewed the literature on NCPB to determine if it has been adequately evaluated in the management of PCP. There have been 15 published series since 1964 on NCPB for PCP. A total of 480 patients with cancer of the pancreas were reported; at least a satisfactory response to NCPB was reported in 418 (87%). We found major deficiencies in these reports. None described the pre-NCPB analgesic history. Post-NCPB data were also limited. No information was given concerning post-NCPB analgesic dosages, and only 4 series stated that most patients did not require opiates. Information on whether NCPB was effective until death was lacking or incomplete in 12 series. Many claimed additional benefits of NCPB such as decreased nausea, decreased constipation, and increased appetite, but none provided any data to support these claims. We conclude that the data available on NCPB for PCP are insufficient to judge for efficacy, long-term morbidity, or cost effectiveness, and rigorous evaluation of the technique is required.
Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, U.S.A. Palliative Care Service, Cleveland Clinic Cancer Center, Cleveland, OH 44195, U.S.A.
William H
WH
Sharfman
Declan T
DT
Walsh
D000698:Analgesia / Q000379:methods*; D002447:Celiac Plexus; D000431:Ethanol / Q000627:therapeutic use; D005069:Evaluation Studies as Topic; D006801:Humans; D007267:Injections; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000628:therapy*
D000431:Ethanol