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Meta-Analysis
. 2011 Mar 16;2011(3):CD007519.
doi: 10.1002/14651858.CD007519.pub2.

Celiac plexus block for pancreatic cancer pain in adults

Paolo G Arcidiacono  1 , Giliola Calori, Silvia Carrara, Ewan D McNicol, Pier A Testoni
Affiliations
Meta-Analysis

Celiac plexus block for pancreatic cancer pain in adults

Paolo G Arcidiacono et al. Cochrane Database Syst Rev. .

Abstract

Background: Pancreatic cancer causes severe pain in 50 to 70% of patients and is often difficult to treat. Celiac plexus block (CPB) is thought to be a safe and effective technique for reducing the severity of pain.

Objectives: To determine the efficacy and safety of celiac plexus neurolysis in reducing pancreatic cancer pain, and to identify adverse effects and differences in efficacy between the different techniques.

Search strategy: We searched Cochrane CENTRAL, MEDLINE, GATEWAY and EMBASE from 1990 to December 2010.

Selection criteria: Randomised controlled trials (RCTs) of CPB by the percutaneous approach or endoscopic ultrasonography (EUS)-guided neurolysis in adults with pancreatic cancer at any stage, with a minimum of four weeks follow-up.

Data collection and analysis: We recorded details of study design, participants, disease, setting, outcome assessors, pain intensity (visual analogue scale (VAS)) and methods of calculation.

Main results: The search identified 102 potentially eligible studies. Judged from the information in the title and abstract six of these concerning the percutaneous block, involving 358 participants, fulfilled the inclusion criteria and were included in the review. All were RCTs in which the participants were followed for at least four weeks. We excluded studies published only as abstracts. We identified one RCT comparing EUS-guided or computed tomography (CT) -guided CPB but its aim was to assess efficacy in controlling chronic abdominal pain associated with chronic pancreatitis rather than pancreatic cancer, so it was excluded.For pain (VAS) at four weeks the mean difference was -0.42 in favour of CPB (95% confidence interval (CI) -0.70 to - 0.13, P = 0.004, fixed-effect model). At eight weeks the mean difference was -0.44 (95% CI -0.89 to - 0.01, random-effects model). At eight weeks there was significant heterogeneity (I(2) = 89%).Opioid consumption was significantly lower in the CPB group than the control group (P < 0.00001).

Authors' conclusions: Although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients. Further studies and RCTs are recommended to demonstrate the potential efficacy of a less invasive technique under EUS guidance.

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Conflict of interest statement

None known

Figures

1
1
Risk of bias graph: it shows the lack of information in the studies: in most of the studies the sequence generation was not explained. The 50% of studies were blinded (see also Figure 2).
2
2
Risk of bias summary. Only one clearly specified how the allocation sequence had been generated and how allocation had been concealed. Three studies were double‐blinded and the others were not.
3
3
Forest plot of comparison: 1 'CPB versus analgesic therapy (VAS)' follow up at 4 weeks.
4
4
Forest plot of comparison: 1 CPB versus analgesic therapy, outcome: 1.2 Pain VAS at 8 weeks.
5
5
Forest plot of comparison: 1 CPB versus analgesic therapy, outcome: 1.3 Opioid use at 4 weeks.
6
6
Forest plot of comparison: 1 CPB versus analgesic therapy, outcome: 1.4 Opioid use the day before death.
1.1
1.1. Analysis
Comparison 1 CPB versus analgesic therapy, Outcome 1 Pain VAS at 4 weeks.
1.2
1.2. Analysis
Comparison 1 CPB versus analgesic therapy, Outcome 2 Pain VAS at 8 weeks.
1.3
1.3. Analysis
Comparison 1 CPB versus analgesic therapy, Outcome 3 Opioid use at 4 weeks.
1.4
1.4. Analysis
Comparison 1 CPB versus analgesic therapy, Outcome 4 Opioid use the day before death.
1.5
1.5. Analysis
Comparison 1 CPB versus analgesic therapy, Outcome 5 Adverse effects: diarrhoea.
1.6
1.6. Analysis
Comparison 1 CPB versus analgesic therapy, Outcome 6 Adverse effects: constipation.
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  • doi: 10.1002/14651858.CD007519

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References

References to studies included in this review

Kawamata 1996 {published data only}
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Gress 1999 {published data only}
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