title: Celiac plexus block for pancreatic cancer pain in adults.
abstract: BACKGROUND
  Pancreatic cancer causes severe pain in 50 to 70% of patients and is often difficult to treat. Celiac plexus block (CPB) is thought to be a safe and effective technique for reducing the severity of pain.
  
  
  OBJECTIVE
  To determine the efficacy and safety of celiac plexus neurolysis in reducing pancreatic cancer pain, and to identify adverse effects and differences in efficacy between the different techniques.
  
  
  METHODS
  We searched Cochrane CENTRAL, MEDLINE, GATEWAY and EMBASE from 1990 to December 2010.
  
  
  METHODS
  Randomised controlled trials (RCTs) of CPB by the percutaneous approach or endoscopic ultrasonography (EUS)-guided neurolysis in adults with pancreatic cancer at any stage, with a minimum of four weeks follow-up.
  
  
  METHODS
  We recorded details of study design, participants, disease, setting, outcome assessors, pain intensity (visual analogue scale (VAS)) and methods of calculation.
  
  
  RESULTS
  The search identified 102 potentially eligible studies. Judged from the information in the title and abstract six of these concerning the percutaneous block, involving 358 participants, fulfilled the inclusion criteria and were included in the review. All were RCTs in which the participants were followed for at least four weeks. We excluded studies published only as abstracts. We identified one RCT comparing EUS-guided or computed tomography (CT) -guided CPB but its aim was to assess efficacy in controlling chronic abdominal pain associated with chronic pancreatitis rather than pancreatic cancer, so it was excluded.For pain (VAS) at four weeks the mean difference was -0.42 in favour of CPB (95% confidence interval (CI) -0.70 to - 0.13, P = 0.004, fixed-effect model). At eight weeks the mean difference was -0.44 (95% CI -0.89 to - 0.01, random-effects model). At eight weeks there was significant heterogeneity (I(2) = 89%).Opioid consumption was significantly lower in the CPB group than the control group (P < 0.00001).
  
  
  CONCLUSIONS
  Although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients. Further studies and RCTs are recommended to demonstrate the potential efficacy of a less invasive technique under EUS guidance.
authors.affiliation: Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Institute, Via Olgettina 60, Milano, Lombardia, Italy, 21032.
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Arcidiacono
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Silvia
authors.initials: S
authors.lastname: Carrara
authors.forename: Ewan D
authors.initials: ED
authors.lastname: McNicol
authors.forename: Pier A
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods*; D002447:Celiac Plexus; D006801:Humans; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid