title: Adding triamcinolone to endoscopic ultrasound-guided celiac plexus blockade does not reduce pain in patients with chronic pancreatitis.
abstract: OBJECTIVE
  The efficacy of endoscopic ultrasound-guided celiac plexus blockade (EUS-CPB) for painful chronic pancreatitis (CP) is uncertain. Triamcinolone is often mixed with bupivacaine to lengthen the analgesic effect. We investigated whether addition of triamcinolone increases and lengthens pain relief compared with EUS-CPB with only bupivacaine.
  
  
  METHODS
  We performed a single-center, blinded, randomized, controlled trial of 40 adult patients referred for EUS-CPB for treatment of painful CP. Patients were assigned randomly to groups that received EUS-CPB with triamcinolone and bupivacaine or EUS-CPB with only bupivacaine (control). Questionnaires were collected when the study began (baseline) and 1 month later. The primary end point was a decrease in the pain disability index of 10 or more points at 1 month after the procedure. Secondary end points included change in visual analogue scale, narcotic requirements, and quality of life at 1 month.
  
  
  RESULTS
  There were no significant differences in primary outcomes between groups (14.3% for patients who received triamcinolone vs 15.8% for controls; P = .64). The trial was stopped for futility. There was no significant difference between groups in immediate response rates (85.7% for patients who received triamcinolone vs 68.4% for control; P = .10), or other secondary end points, including change in pain visual analogue scale (0.4 vs 1.0; P = .83), treatment with morphine equivalents at 1 month (-7.8 vs 0.0; P = .35), change in quality of life at 1 month (SF-12 mental component: 1.3 vs -2.1; P = .44; and physical component: -0.2 vs 1.7; P = .54), or adverse events. The duration of response was shorter in the triamcinolone group (mean, 5.3 vs 0.6 mo; P = .01).
  
  
  CONCLUSIONS
  Triamcinolone does not increase pain relief or lengthen the effects of EUS-CPB.
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. @ccf.org
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.forename: Adele
authors.initials: A
authors.lastname: Costanzo
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D002447:Celiac Plexus / Q000187:drug effects*; D004359:Drug Therapy, Combination / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005730:Ganglionic Blockers / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy*; D050500:Pancreatitis, Chronic / Q000150:complications*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D005730:Ganglionic Blockers; D014221:Triamcinolone; D002045:Bupivacaine