Comparative Study of the Effects of the Retrocrural Celiac Plexus Block Versus Splanchnic Nerve Block, C-arm Guided, for Upper Gastrointestinal Tract Tumors on Pain Relief and the Quality of Life at a Six-month Follow Up

Abstract

Background: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors.

Methods: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed.

Results: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable.

Conclusions: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.

Keywords: Abdominal pain; Autonomic nerve block; Celiac plexus; Chemical neurolysis; Gastrointestinal neoplasms; Pain measurement; Quality of life; Splanchnic nerves; Treatment outcome.

Fig. 1

(A) Celiac plexus block: posteroanterior view of both needles with the needle tip at the level of the intradiscal space between the T12 and L1 vertebrae at the facetal line. (B) Celiac plexus block: lateral view with both needles with the needle tips at the antero-lateral border of the vertebral body and dye distribution. (C) Splanchnic nerve block: posteroanterior view with the contrast material spread adherent to the T11 vertebral body (left side). (D) Splanchnic nerve block: lateral view, with the needle tip stopping at the junction of the anterior one third and posterior two thirds of the vertebral body with contrast material spread at the level of T11.

Fig. 2

Flow diagram of patient progress through the phases of the randomized trial.

Fig. 3

(A-G) Comparison between QLQ C-30 scales before the block and during the follow-up periods for both groups. Data were presented as means ± standard deviations.

Fig. 4

Kaplan Meier curve for patient survival rates of both groups (P value = 0.591).