Ultrasound-guided alcoholization of celiac plexus for pain control in oncology.
BACKGROUND
Treatment of inoperable pancreatic cancer pain is of paramount importance. The ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions for pain control. This procedure may be performed under either fluoroscopic or computed tomography (CT) guidance, or it may accompany laparotomy. The authors describe a modified sonographically (ultrasound-US)-guided technique for alcoholization of the celiac ganglions.


METHODS
Twelve patients underwent the neurolytic procedure. Nine of 12 suffered from pancreatic cancer. The remaining three were affected by inoperable hepatic, gastric, or colon cancer, respectively, with multiple hepatic metastases. US-guided alcohol neurolysis was performed by an anterior approach. In the last four patients, PIA (percutaneous injection alcohol) needles, modified by the authors, replaced the spinal needles employed in the first eight patients to inject the alcohol. Pain and pain relief were rated according to a Simple Descriptive Scale (SDS), and treatment success was gauged by declining opiate doses and need for pharmacological therapy. Results after treatment performed using different needles were compared.


RESULTS
Procedure-related mortality was zero. Complications of the neurolytic procedure included left pleural effusion in one patient and mild diarrhea in two other patients. Positive, negative, and indeterminant results were noted in nine (75%, p < 0.001), two, and one patient(s), respectively.


CONCLUSIONS
The neurolytic technique, although far from being considered a routine procedure, appears to provide patients with safe and effective pain relief for pain unresponsive to conventional medical treatment.
Caratozzolo
M
M
IV Clinica Chirurgica, Università degli Studi di Roma "La Sapienza," Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy.
Lirici
M M
MM
Consalvo
M
M
Marzano
F
F
Fumarola
E
E
Angelini
L
L
D000368:Aged; D001340:Autonomic Nerve Block / Q000379:methods*; D002447:Celiac Plexus; D003110:Colonic Neoplasms / Q000503:physiopathology; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009339:Needles; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000503:physiopathology; D013274:Stomach Neoplasms / Q000503:physiopathology; D014463:Ultrasonography
D000431:Ethanol