title: The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study.
abstract: BACKGROUND
  Celiac plexus neurolysis (CPN) is an effective but temporary management tool for pancreatic cancer pain (PCP). Clinical studies have shown the duration of benefit with initial CPN to be apaproximately 3 months. When pain recurs, CPN may be repeated, but the outcomes for repeat CPN are not well established. The objective of this study is to determine the success rate and duration of relief following repeat celiac plexus neurolysis (rCPN) for PCP.
  
  
  METHODS
  Patients who underwent rCPN were identified from a database and their records reviewed. Responses of rCPN were then compared with iCPN for success rates and duration of relief. Success was defined as ≥ 50% pain relief lasting ≥ 1 month.
  
  
  RESULTS
  Overall, there were 24 rCPN performed. The success rate decreased from 67% after initial CPN to 29% following rCPN (P = 0.13). The mean duration of pain relief decreased in parallel from 3.4 months (iCPN) to 1.6 months (rCPN) (P = 0.03). Among those who had a successful rCPN, 2.9 months elapsed from iCPN to rCPN, with disease progression noted in 29%. In those who failed rCPN, 7.8 months elapsed, with disease progression apapreciated in 71% of cases.
  
  
  CONCLUSIONS
  rCPN does not provide as much pain relief as iCPN. Disease progression as detailed on imaging appears to be a major factor in the limitations of rCPN. Further prospective studies are warranted to confirm these results and investigate the utility of rCPN.
authors.affiliation: Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Kai
authors.initials: K
authors.lastname: McGreevy
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hurley
authors.forename: Michael A
authors.initials: MA
authors.lastname: Erdek
authors.forename: Musa M
authors.initials: MM
authors.lastname: Aner
authors.forename: Sean
authors.initials: S
authors.lastname: Li
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
mesh_terms: D002447:Celiac Plexus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000601:surgery*; D059408:Pain Management / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D010865:Pilot Projects; D012189:Retrospective Studies