Bedside ultrasound-guided celiac plexus neurolysis in upper abdominal cancer patients: a randomized, prospective study for comparison of percutaneous bilateral paramedian vs. unilateral paramedian needle-insertion technique.
BACKGROUND
Percutaneous anterior abdominal ultrasound guidance for performing celiac plexus neurolysis is a relatively new but more economical, less time-consuming, more comfortable bedside technique for interventional pain management. Paucity of studies evaluating the efficacy of single-site vs. double-site injections at celiac trunk for ultrasound-guided celiac plexus neurolysis (USCPN) prompted us to conduct a prospective, randomized, single-blind clinical trial to compare USCPN using bilateral paramedian (double needle) technique with unilateral paramedian (single needle) technique.


METHODS
Sixty patients aged 18 years or older with unresectable upper abdominal cancers were randomized into two groups to receive USCPN. A 20-mL mixture of 50% ethanol with 0.25% bupivacaine was injected either unilaterally (20 mL×1 site) or bilaterally (10 mL×2 sites) depending on the randomization group. Subjects were assessed for the pain relief using Numerical rating scale (NRS) to assess their pain relief.


RESULTS
Baseline parameters being comparable (P > 0.05), the site of drug injections (single or double needle) had no bearing on the onset of pain relief and patient satisfaction scores (P > 0.05). Pain relief during follow-up visits was comparable between the two groups (P > 0.05). The discomfort score correlated well with the pain relief scoring without any significant difference between the two groups except in the last visit (at 3 month). Incidences of the complications were comparable in the two groups (P > 0.05).


CONCLUSIONS
Ultrasound-guided celiac plexus neurolysis using unilateral paramedian (single needle) needle-insertion technique is comparable with bilateral paramedian (double needle) needle-insertion technique with regard to pain relief and side effects.
Department of Anaesthesiology, Pain and Palliative Care, IRCH, AIIMS, New Delhi, India.
Sushma
S
Bhatnagar
Saurabh
S
Joshi
S P S
SP
Rana
Seema
S
Mishra
Rakesh
R
Garg
Syed M
SM
Ahmed
D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002447:Celiac Plexus / Q000000981:diagnostic imaging* / Q000187:drug effects; D005260:Female; D005706:Gallbladder Neoplasms / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000503:physiopathology*; D019095:Point-of-Care Systems; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D000779:Anesthetics, Local; D002045:Bupivacaine
abdominal malignancies; double needle; pain relief; randomized controlled trial; single needle; ultrasound-guided celiac plexus neurolysis