title: Neurolytic celiac plexus block reduces occurrence and duration of terminal delirium in patients with pancreatic cancer.
abstract: OBJECTIVE
  WHO's three step ladder sometimes cannot provide adequate pain relief for pancreatic cancer. Some patients develop terminal delirium (TD). The aim of this study was to test if the addition of a celiac plexus block (CPB) to pharmacotherapy could reduce the incidence of TD.
  
  
  METHODS
  Pancreatic cancer patients under the care of our palliative-care team were investigated with regard to the duration and occurrence of TD, pain scores [numerical rating score (NRS)] and daily opioid dose. Between August 2007 to September 2008, 17 patients received only pharmacotherapy (control group). Then, we modified our guideline for analgesia, performing CPB 7 days after the first intervention of our team. Between October 2008 to September 2009, 19 patients received CPB.
  
  
  RESULTS
  The opioid doses in CPB group were significantly lower both at 10 days after the first intervention (3 days after CPB) (27 ± 11 vs. 66 ± 82 mg; p = 0.029) and 2 days before death (37 ± 25 vs. 124 ± 117 mg; p = 0.009). NRS in the CPB group were significantly lower both at 10 days after the first intervention (0 [0-2] vs. 3 [2-5], p < 0.0001) and 2 days before death (1 [0-2] vs. 3 [1-4.5], p = 0.018). The occurrence and duration of TD in CPB group were both reduced (42 vs. 94 %, p = 0.019; and 1.8 ± 2.9 vs. 10.4 ± 7.5 days, p = 0.0003).
  
  
  CONCLUSIONS
  The duration and occurrence of TD and the pain severity were significantly less in pancreatic cancer patients who underwent neurolytic CPB.
authors.affiliation: Multidisciplinary Pain Centre, Aichi Medical University, School of Medicine, 21 Karimata, Nagakutecho, Aichigun, Aichi, 480-1195, Japan. arainon@aichi-med-u.ac.jp
authors.forename: Young-Chang P
authors.initials: YC
authors.lastname: Arai
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishihara
authors.forename: Kunio
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kanazawa
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Hayashi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tohyama
authors.forename: Kikuyo
authors.initials: K
authors.lastname: Nishida
authors.forename: Maki
authors.initials: M
authors.lastname: Arakawa
authors.forename: Chiharu
authors.initials: C
authors.lastname: Suzuki
authors.forename: Akiko
authors.initials: A
authors.lastname: Kinoshita
authors.forename: Miki
authors.initials: M
authors.lastname: Kondo
authors.forename: Satuki
authors.initials: S
authors.lastname: Matsubara
authors.forename: Nami
authors.initials: N
authors.lastname: Yokoe
authors.forename: Ruiko
authors.initials: R
authors.lastname: Hayashi
authors.forename: Aya
authors.initials: A
authors.lastname: Ohta
authors.forename: Jun
authors.initials: J
authors.lastname: Sato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ushida
mesh_terms: D000368:Aged; D002447:Celiac Plexus; D003693:Delirium / Q000209:etiology* / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000523:psychology; D025321:Surgery, Computer-Assisted; D013727:Terminal Care; D014057:Tomography, X-Ray Computed