Ultrasound guided celiac plexus neurolysis by anterior approach for pain management in upper abdominal malignancy: Our experience

Abstract

Objectives: Celiac plexus neurolysis is adjunct modality to relieve intractable pain caused by upper
abdominal malignancy. An anterior approach offers advantages including shorter procedure time,
less discomfort and less risk of neurological complications. The CT and ultrasound help to improve
visualization of the celiac plexus. Their use allow accurate needle placement and reduce the risks. We
report our experience with sonographically guided anterior approach to celiac plexus neurolysis in upper
abdominal malignancy patients.
Methodology: Patients with upper abdominal malignancy with VAS ≥3 not responding to diclofenac
and demanding additional opioids or those having adverse effects were included. A prognostic block
was performed under deep sedation with sonographic guidance using 22G, 15cm long Chiba needle
advanced through biopsy guide to the preaortic zone above takeoff of celiac artery. Thirty to forty ml
of 50% alcohol was injected. The VAS scores, analgesic consumption, duration of complete and partial
pain relief were assessed at one hour, 24 hours, one week, one month, two month and three month
intervals.
Results: Fifteen patients were enrolled There was statistically significant decrease in mean VAS score at
1st hour, 24th hour, 1st week, 1st, 2nd and 3rd month respectively (p< 0.05). The analgesic consumption
was statistically significant at all time intervals from baseline (p< 0.05).
Conclusion: Use of color doppler helps in real time positioning of needle It is successful in terminally
ill patients.