title: Assessment of celiac plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain.
abstract: OBJECTIVE
  To assess demographic and clinical factors associated with celiac plexus neurolysis outcomes.
  
  
  METHODS
  Retrospective clinical data analysis.
  
  
  METHODS
  A tertiary care, academic medical center.
  
  
  METHODS
  Forty-four patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures. Interventions. Fifty celiac plexus alcohol neurolytic procedures done for pain control after a positive diagnostic block.
  
  
  METHODS
  A successful treatment was predefined as >50% pain relief sustained for > or =1 month. The following variables were analyzed for their association with treatment outcome: age, gender, duration of pain, origin of tumor, opioid dose, type of radiological guidance used, single- vs double-needle approach, type of block (e.g., antero- vs retrocrural), immediate vs delayed neurolysis, volume of local anesthetic employed for both diagnostic and neurolytic blocks, and use of sedation.
  
  
  RESULTS
  Those variables correlated with a positive outcome included lower opioid dose and the absence of sedation. Strong trends for a positive association with outcome were found for the use of computed tomography (vs fluoroscopy), and using <20 mL of local anesthetic for the diagnostic block.
  
  
  CONCLUSIONS
  Celiac plexus neurolysis may provide intermediate pain relief to a significant percentage of cancer sufferers. Both careful selection of candidates based on clinical variables, and technical factors aimed at enhancing the specificity of blocks may lead to improved outcomes.
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA. merdek@jhmi.edu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Erdek
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Halpert
authors.forename: Marlís
authors.initials: M
authors.lastname: González Fernández
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001340:Autonomic Nerve Block; D002447:Celiac Plexus; D004351:Drug Resistance; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D010148:Intractable Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013562:Sympathectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local