Pain Management

Cancer Pain Management

Prospective Evaluation of Laparoscopic Celiac Plexus Block in Patients with Unresectable Pancreatic Adenocarcinoma

Allen PJ, Chou J, Janakos M, et al (Memorial Sloan-Kettering Cancer Ctr, NY) Ann Surg Oncol 18:636-641, 2011^§

Abstract

Introduction

The efficacy of laparoscopic celiac plexus block (CPB) in patients with unresectable pancreatic cancer has not been reported.

Methods

Patients with elevated pain scores scheduled for laparoscopy for diagnosis/staging of unresectable pancreatic adenocarcinoma were eligible. The study was designed to evaluate 20 consecutive patients with validated quality of life (EORTC QLQ-C30, QLQ-PAN26) and validated pain assessment tools [Brief Pain Inventory (BPI)]. Questionnaires were obtained preoperatively, and postoperatively at 1, 4, and 8 weeks. Laparoscopic CPB was performed by bilateral injection of 20 cc 50% alcohol utilizing a recently described laparoscopic technique. Functional and symptom scoring was performed by EORTC scoring manual.

Results

Median age was 61 years (range 42–80 years), and mean preoperative pain score [worst in 24 h on 0–10 visual analogue scale (VAS)] was 7.8 [standard deviation (SD) 1.6]. Median total operative time (laparoscopy + biopsy + CBP) was 57 min (range 29–92 min), and all patients except one were discharged on day of surgery. No major complications occurred. EORTC functional scales did not change significantly during the postoperative period. EORTC symptomatic pain scores decreased significantly. These findings were also observed in the BPI, with significant decreases in visual analogue score for reported mean (preoperative versus week 4, mean: 5.7 versus 2.7; p < 0.01) and worst (preoperative versus week 4, mean: 7.8 versus 5.1; p < 0.01) pain during a 24-h period.

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