[Analgesic effect of neurolytic celiac plexus block guided by ultrasonography in advanced malignancies]

Abstract

Objective: To investigate the analgesic effect of celiac plexus block with anhydrous alcohol in patients suffering form advanced abdominal malignancies.

Methods: Ultrasonographically demonstrated and guided, 20 to 50 ml of anhydrous alcohol is injected into the celiac plexus and superior mesenteric plexus by fine needle of 22G. The injecting angle between the needle and the aorta is 20 to 30 degree. The injecting fields mainly located around the celiac plexus and the dorsal part of tumor are also injected. Sometimes if the tumor is rather large, an appropriate amount of alcohol was injected inside too.

Results: Twenty-eight cases of advanced abdominal malignancies were treated, among whom 96.4% achieved analgesic effect of different degree, 53.6% (15 cases) achieved the period of pain relief over three days, and 42.8% (12 cases) achieved partial relief. The analgesic effect is correlated with the amount of alcohol injected, i.e. no complete relief was observed in the four patients who received less than 12 ml, while two out of six could get transient complete relief in those who received 15 to 28 ml. In the group of 30 to 50 ml, 72.2% (13 cases) could get complete pain relief. Nine cases with big tumor received injection in side the tumor, with six tumors resulting in shrinkage or necrosis, significant pain relief also achieved in these cases. Complications occurred in nine cases (32.1%), with four cases of postural hypotension, two cases of vomiting, two cases of hiccup and one case of diarrhea.

Conclusion: Neurolytic celiac plexus block guided by ultrasonography is a safe and effective modality in the management of intractable pain resulted from advanced abdominal malignancies.