title: Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA. rmccarth@rpslmc.edu
authors.forename: M
authors.initials: M
authors.lastname: Shulman
authors.forename: J E
authors.initials: JE
authors.lastname: Harris
authors.forename: T R
authors.initials: TR
authors.lastname: Lubenow
authors.forename: H A
authors.initials: HA
authors.lastname: Nath
authors.forename: A D
authors.initials: AD
authors.lastname: Ivankovich
mesh_terms: 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
chemical_list: D000779:Anesthetics, Local; C004605:butamben; D001566:Benzocaine