Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer.
OBJECTIVE
To compare pain relief in metastatic pancreatic cancer patients between neurolytic celiac plexus block (NCPB) and epidural 5% butamben suspension (EBS), a material-based delivery system of a local anesthetic that produces a long-lasting differential nerve block.


METHODS
Open-label patient-selected parallel groups.


METHODS
Urban tertiary care medical center.


METHODS
Twenty-four adult patients with metastatic pancreatic cancer experiencing pain uncontrolled by systemic opioids who were referred to a multidisciplinary pain clinic for interventional therapy.


METHODS
Antecrural NCPB-block with ethanol and epidural 5% butamben suspension injections.


METHODS
Subjective global pain relief assessments on a 0-100% scale were made weekly for 4 weeks and then monthly. Change in opioid use postintervention.


RESULTS
Eight patients had a single NCPB and three patients had two NCPB. Four of the former and two of the latter had successful pain relief defined to be a more than 75% reduction in pain when compared with pretreatment maintained for more than 4 weeks or until death (if less than 4 weeks). Thirteen patients received EBS in divided doses. Eleven patients received a cumulative EBS dose of 5 grams, one patient received a cumulative EBS dose of 2.5 grams, and one patient received a cumulative EBS dose of 8.75 grams. Nine of the eleven patients and each of the other two patients had successful pain relief. The overall incidence (85% EBS vs. 55% NCPB), the duration of successful pain relief, and the percent reduction in opioid use did not differ between the two groups. There were no serious complications.


CONCLUSIONS
EBS appears to be a safe and effective alternative to NCPB in the treatment of pancreatic cancer pain.
Shulman
M
M
Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA. rmccarth@rpslmc.edu
Harris
J E
JE
Lubenow
T R
TR
Nath
H A
HA
Ivankovich
A D
AD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001566:Benzocaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D002447:Celiac Plexus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000150:complications*; D016896:Treatment Outcome
D000779:Anesthetics, Local; C004605:butamben; D001566:Benzocaine