An open randomized comparison of clinical effectiveness of protocol-driven opioid analgesia, celiac plexus block or thoracoscopic splanchnicectomy for pain management in patients with pancreatic and other abdominal malignancies.
In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM).


METHODS
Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB, or MM+TS. Randomization was stratified by treatment centre, tumour type and previous opioid medication. The primary endpoint was pain relief at 2 months.


RESULTS
65 patients (58 pancreas cancer) were randomized, 18 withdrew or died within 2 months. Effective pain relief was achieved in only one third of subjects at 2 weeks, and just under half at 2 months (MM: 6/19 and 5/12 evaluable patients; CPB: 5/14 and 5/9; TS 4/14 and 4/11). There were no significant differences between the groups in pain scores or opioid consumption, and there was no correlation between continued use of opioids and effective pain relief.


CONCLUSIONS
Previous randomized studies have shown small differences in pain scores, but no difference in opioid consumption and quality of life. The absence of any benefit from interventions in the present study questions their value.
Johnson
Colin D
CD
University Surgical Unit (816), Southampton General Hospital, Southampton, UK. c.d.johnson@soton.ac.uk
Berry
D P
DP
Harris
S
S
Pickering
R M
RM
Davis
C
C
George
S
S
Imrie
C W
CW
Neoptolemos
J P
JP
Sutton
R
R
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002447:Celiac Plexus / Q000187:drug effects / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D059408:Pain Management; D010190:Pancreatic Neoplasms / Q000150:complications*; D013153:Splanchnic Nerves / Q000601:surgery*; D016896:Treatment Outcome
D000701:Analgesics, Opioid