Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis.
We performed a meta-analysis of the efficacy and safety of neurolytic celiac plexus block (NCPB) for cancer pain. A literature search yielded 59 papers, but data on NCPB in two or more patients was available in only 24 papers. Twenty-one studies were retrospective, one was prospective, and two were randomized and controlled. Cancer type was stated in 1117 of 1145 patients reported (63% pancreatic, 37% nonpancreatic). A bilateral posterior approach with 15-50 mL [corrected] of 50%-100% alcohol was the most common technique. Nonradiologically guided NCPB was performed in 246 patients (32%); guidance was by computed tomography (CT) in 214 (28%), radiograph in 271 (34%), fluoroscopy in 36 (5%), or ultrasound in 7 (< 1%). Good to excellent pain relief was reported in 878/989 patients (89%) during the first 2 wk after NCPB. Long-term followup beyond 3 mo revealed persistent benefit. Partial to complete pain relief continued in approximately 90% of patients alive at 3 mo post-NCPB and in 70%-90% until death even if beyond 3 mo post-NCPB. Patients with pancreatic cancer responded similarly to those with other intraabdominal malignancies. Common adverse effects were transient, including local pain (96%), diarrhea (44%), and hypotension (38%); complications occurred in 2%. This analysis suggests that: 1) NCPB has long-lasting benefit for 70%-90% of patients with pancreatic and other intraabdominal cancers, regardless of the technique used; 2) adverse effects are common but transient and mild; and 3) severe adverse effects are uncommon.
Eisenberg
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Department of Neurology, Massachusetts General Hospital, Boston.
Carr
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DB
Chalmers
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TC
D002447:Celiac Plexus; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management; D010190:Pancreatic Neoplasms / Q000150:complications; D015641:Radiography, Interventional; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional