| The Efficacy of Celiac Plexus Block in Management of Breakthrough Pain in Patients with Advanced Cancer |
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Min-Soo Kim, Tae-Kyu Lee, Sei-Yun Yang, Tae-Yeon Won, Sang-Bok Lee, Do-Sung Yoo, Pil-Woo Huh, Kyung-Souk Cho |
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Department of Neurosurgery, Uijeongbu St Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea |
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| Abstract |
Purpose
We retrospectively analyzed the outcome of 35 patients with breakthrough pain in advanced cancer in upper abdomen to evaluate whether celiac plexus block (CPB) is effective and safe in management for breakthrough pain of cancer pain.
Methods
and Materials: Data was collected retrospectively on 35 patients undergoing CPB in management of breakthrough
pain in patients with advanced pancreatic cancer, stomach cancer, hepatoma and periampullary cancer during a 5-year period
beginning on January 1, 2010. These patients additionally complained heterogeneous and strong pain in upper abdomen and
back with features such as vague, burning and dull nature and did not respond to medication with rapid-onset or short-acting
opioid in breakthrough pain. CPB under fluoroscopy was performed. The mixture of 2mL of 0.5% bupivacaine and 1mL of
methylprednisolone was injected around celiac plexus under fluoroscopy. Pain intensity was measured using a visual analogue
score (VAS) and morphine consumption were measured at baseline and after celiac plexus block. Karnofsky performance status
scale (KPS) was checked in same group as identical manner.
Results
The mean (±SD) VAS of baseline status was 7.2 (±1.8) before CPB in management of breakthrough pain in advanced
cancer patients. VAS decreased to 3.66±1.34 at 1 day after CPB compared with baseline VAS and was sustained by 2.94±
0.93 during 1 week and by 3.00±0.88 at 2 weeks. The baseline dose was 124±117 mg/day that significantly reduced to 27±
11mg/day after the first 24 hours post-procedure (p=0.001). The reduction by 32±17mg/day in daily morphine consumption
was observed at 1 week after CPB compared with the baseline and after 2 weeks, the mean dose value (±SD) was also significantly reduced by 34±17. There was no difference of KPS in patients with advanced cancer regardless of CPB.
Conclusion
Our study suggests that CPB reduces pain intensity for breakthrough pain in advanced cancer and lower required
dose of morphine consumption. These effects last for 2 weeks and sustain partially until 2 days before death in patients with
advanced cancer in upper abdomen. |
| Key Words:
Breakthrough pain, Background pain, Celiac plexus block. |
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