Outcome and Evaluation of Celiac Plexus Block (CPB) Enhancement Level of Well-Being in Patient's Pancreatic Cancer Pain: Study on Tertiary Hospital in Bangladesh (original) (raw)
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Is quality of life improved by neurolytic coeliac plexus block in pancreatic cancer pain management
2018
Pancreatic cancer (PC) is a disease of insidious onset and late clinical presentation with an annual incidence of 100 per million population. It is the sixth most common cause of mortality from cancer and records a median survival of about 3–6 months without treatment. Quality of life (QOL) is the major consideration in the management of advanced cancer. PC adversely affects QOL of sufferers and mostly presents with abdominal pain from intra- and extra-pancreatic origins. Opioids are the “Gold-standard” treatment in severe cancer pain management. However, its use may be challenged by debilitating side effects such as drowsiness, respiratory depression, constipation, nausea/vomiting, or opioid toxicity which further worsens QOL of patients burdened with cancer. Neurolytic celiac plexus block (NCPB) is indicated in PC pain that is resistant or refractive to conventional analgesic methods. Such potent analgesic technique could ease the suffering of cancer patients and provides an improved QOL. Reports indicate that NCPB provides effective analgesia in advanced PC but might be associated with minor and transient side effects such as hypotension, diarrhea, and retroperitoneal hemorrhage. Reports from studies analyzed in this review show that NCPB provides superior analgesia in PC pain management than opioid-based therapies. However, there is no satisfactory evidence that NCPB improved QOL in these patients. This shows that QOL of advanced cancer patients is not synonymous with pain relief. Improvement in QOL will be difficult without management of the “total pain” felt by the patients. Keywords: Block, coeliac plexus, pain-management, pancreatic-cancer, quality-of-life
The Clinical Journal of Pain, 2013
Background: The efficacy of a celiac plexus block for the treatment of upper abdominal cancer-related pain has been documented. However, the effect of preprocedural pharmacological control of pain on its efficacy remains unknown. The researchers investigated the effect of first controlling severe pain with medications and then performing the celiac plexus block and compared the results with those obtained when the celiac block was performed first followed by pharmacotherapy for controlling severe pain; the impact on and duration of pain relief, effect on the quality of life, and analgesic requirements were analyzed.
Pain, 1996
Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block (CPB) on pain relief and quality of life (QOL), compared to the traditional NSAID-morphine treatment. The criteria were morphine consumption, visual analogue pain scale (VAS), performance status (PS) determined by medical and nursing staffs, and answers to QOL questionnaires. Morphine consumption, VAS, PS, and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control. Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter. CPB was performed within 2-3 days after the control measurement. The VAS scores of the patients receiving CPB (n = 10) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the standard NSAID-morphine treatment (n = 11) during the sa...
Scholars journal of applied medical sciences, 2022
Original Research Article Introduction: Pancreatic cancer is a formidable health problem with increasing incidence. Worldwide, over 200000 people die annually of pancreatic cancer Because of high fatality rates; pancreatic cancer incidence rates are almost equal to mortality rates. Pancreatic cancer is diagnosed late in the natural history of the disease, giv en the few early indicators of illness, and the lack of screening tests for this disease. Neurolytic celiac plexus block (NCPB) is commonly used to treat pain of upper abdominal cancer that fails to respond to narcotic analgesics. CPB refers to the temporary inhibition of the celiac plexus often achieved with a corticosteroid injection in patients with benign pancreatic diseases like chronic pancreatitis. Aim of the study: The aim of this study was to determine and compare the adverse effect of analgesics and coeliac plexus block in relieving pain in carcinoma of pancreas. Methods: This study was a randomized comparative study and was conducted in the
Pain Management in Pancreatic Cancer
Cancers, 2010
A majority of pancreatic cancer patients present with pain at the time of diagnosis. Pain management can be challenging in light of the aggressive nature of this cancer. Apart from conventional pharmacotherapy, timely treatment with neurolytic celiac plexus block (NCPB) has been shown to be of benefit. NCPB has demonstrated efficacious pain control in high quality studies with analgesic effects lasting one to two months. NCPB has also shown to decrease the requirements of narcotics, and thus decrease opioid related side effects. Another option for the control of moderate to severe pain is intrathecal therapy (IT). Delivery of analgesic medications intrathecally allows for lower dosages of medications and thus reduced toxicity. Both of the above mentioned interventional procedures have been shown to have low complication rates, and be safe and effective. Ultimately, comprehensive pancreatic cancer pain management necessitates understanding of pain mechanisms and delivery of sequential validated therapeutic interventions within a multidisciplinary patient care model.
Celiac plexus block versus analgesics in pancreatic cancer pain
Pain, 1993
Twenty pancreatic cancer patients were studied to assess the effectiveness and duration of celiac plexus block compared to traditional treatment with analgesics by considering the previous and subsequent consumption of narcotics until their death. After 1 week of therapy with NSAID-narcotic sequence according to the WHO method, 10 patients were continued on this treatment, while the other 10 patients underwent celiac plexus block. Subsequently analgesics were administered as in the patients not treated by the block. A visual analogue score and opioid consumption were used to calculate the effective analgesic dose at weekly intervals until death. Celiac plexus block made pain control possible with a reduction in opioid consumption for a mean survival period of about 51 days. Administration of only analgesics resulted in an equal reduction in VAS pain score until death, but with more unpleasant side effects than when using celiac plexus block.
The Role of Neurolytic Celiac Plexus Block in the Treatment of Pancreatic Cancer Pain
Transplantation Proceedings, 2008
Pancreatic carcinoma, an important leading cause of cancer death, has increased steadily in incidence and still has a poor prognosis. Pain is one of the most frequent symptoms, affecting more than 75% of patients. It is often present in the early stages of disease and may be severe and difficult to treat. Abdominal viscera, including pancreas, liver, gallbladder, adrenal, kidney, and the gastrointestinal tract from the level of the gastroesophageal junction to the splenic flexure of the colon are innervated, at least in part, via the celiac plexus. Thus, painful tumors in these viscera may have pain relieved through the use of a neurolytic celiac plexus block (NCPB). Although some investigators questioned the role and the efficacy of NCPB in the treatment of upper abdominal cancer pain, most of them have suggested that it may represent the optimal treatment, especially for pancreatic cancer pain. In this report we have reviewed the techniques, results, and complications of NCPB for the treatment of pancreatic cancer pain.
EAS Journal of Anaesthesiology and Critical Care
Background: Pancreatic cancer is a formidable health problem worldwide with increasing incidence. Debilitating pain is very common in patients with pancreatic cancer. The aim of this study is to observe the effectiveness of neurolytic coeliac plexus block for the relief of pain due to carcinoma of pancreas. Methods: This randomized comparative study carried out in the Department of Anaesthasia, Analgesia and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University, Dhaka with a period from July 2008 to June 2010 for two (2) years. Result: All patients of carcinoma pancreas >18 years of age with both sexes, who were needed palliation for their end stage carcinoma, were included in this study and were divided into two groups of which group A was taken the CPB and group B was taken the conventional treatment. A total number of 30 patients were enrolled in this study of which 15 were in the group A who were treated with the neurolytic celiac plexus block (NCPB) and 15 w...
Neurolytic Celiac Plexus Block Efficacy in Patients with Severe, Chronic Upper-abdominal Cancer Pain
Central Asian Journal of Medical Sciences
Objectives: To study of the efficacy of the neurolytic celiac plexus block (NCPB) in patients with severe, chronic upper-abdominal cancer pain in reducing pain score, morphine consumption, side effects of morphine, and improving performance score. Methods: Fifty-six patients with abdominal cancer who suffered chronic, severe pain were enrolled in this study. All patients received a morphine dose of <100mg/day. Patients were divided into 2 groups: group I included patients who received NCPB, group II included patients who used morphine continuously. The patients' pain score, performance status, morphine consumption and morphine-related side effects were recorded at regular two-week intervals with a final follow-up at eight weeks. Results: After the NCPB administration, the pain score, morphine consumption and morphine-related side effects decreased in group I more than in group II (p <0.0001). The physical performance improved in group I more than group II (p<0.001). In ...