title: A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two?
abstract: BACKGROUND
  The technique of alcohol injection during EUS-guided celiac plexus neurolysis (CPN) in patients with pancreatic cancer-related pain has not been standardized.
  
  
  OBJECTIVE
  To compare pain relief and safety of alcohol given as 1 versus 2 injections during EUS-guided CPN (EUS-CPN). Secondary outcomes examined were characteristics that predict response and survival.
  
  
  METHODS
  Single-blinded, prospective, randomized, parallel-group study.
  
  
  METHODS
  Tertiary-care center.
  
  
  METHODS
  This study involved patients with pancreatic cancer-related pain.
  
  
  METHODS
  EUS-CPN done by injecting 20 mL of 0.75% bupivacaine and 10 mL 98% alcohol into 1 or 2 sites at the celiac trunk. Participants were interviewed by telephone at 24 hours and weekly thereafter.
  
  
  METHODS
  Time until onset of pain relief, duration of pain relief, complications.
  
  
  RESULTS
  Fifty patients (mean age 63 years; 24 men) were enrolled and randomized (29 in 1-injection, 21 in 2-injections groups). Pain relief was observed in 37 (74%) patients: 20 (69%) in the 1-injection group and 17 (81%) in the 2-injection group (chi-square P = .340). Median onset of pain relief was 1 day for both 1-injection (range 1-28 days) and 2-injection (range 1-21 days) groups (Mann-Whitney P = .943). Median duration of pain relief in the 1-injection and 2-injection groups was 11 weeks and 14 weeks, respectively (log-rank P = .612). Complete pain relief was observed in 4 (8%) patients total, 2 in each group. There were no long-term complications.
  
  
  CONCLUSIONS
  Single-blinded study.
  
  
  CONCLUSIONS
  There were no differences in onset or duration of pain relief when either 1 or 2 injections were used. There was no difference in safety or survival between the 2 groups.
authors: Division of Gastroenterology & Hepatology, Indiana University Medical Center/IU Health, Indianapolis, Indiana, USA. juleblan@iupui.edu
authors: Julia K
authors: JK
authors: LeBlanc
authors: Mohammad
authors: M
authors: Al-Haddad
authors: Lee
authors: L
authors: McHenry
authors: Stuart
authors: S
authors: Sherman
authors: Michelle
authors: M
authors: Juan
authors: Kathleen
authors: K
authors: McGreevy
authors: Cynthia
authors: C
authors: Johnson
authors: Thomas J
authors: TJ
authors: Howard
authors: Keith D
authors: KD
authors: Lillemoe
authors: John
authors: J
authors: DeWitt
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002447:Celiac Plexus / Q000000981:diagnostic imaging / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000628:therapy; D011446:Prospective Studies; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine