Celiac Plexus Block - An Old Technique with New Developments

Abstract

Background: Celiac plexus block (CPB) is an interventional technique known to be effective in the management of abdominal pain caused by pancreatic cancer.

Objective: To review the journey of CPB as an interventional analgesic technique from its inception to its current status in the field of cancer pain management.

Study design: Descriptive review.

Methods: PubMed database was searched for celiac plexus block, celiac plexus neurolysis, and pancreatic cancer pain relief. Randomized control trials and case series with more than 10 patients were included. A second search was done from the references of all the included articles to add studies fulfilling the inclusion criteria which were missed in the first broad search.

Results: A total of 44 studies were included in this literature review. Available evidence through the years was categorized based on the imaging technique used to guide needle insertion and studies were tabulated based on study design, the number of patients included, the technique of CPB, and the conclusions drawn.

Limitations: Meta-analysis of the available studies was not done because of heterogeneous nature of studies.

Conclusion: Over the years, the majority of clinical trials have focused on fluoroscopy-guided CPB. Computed tomography-guided blockade of celiac plexus is the next choice among pain physicians and percutaneous ultrasound-guided CPB is a relatively new technique. The data generated over the years does not point to a single technique being the gold standard for CPB and choice of technique may be guided by the individual's preference, familiarity with the technique, and institutional practice.

Keywords: coeliac plexus block; coeliac plexus neurolysis; Pancreatic cancer.