Journal of Neurology and Neuroscience

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Intraoperative Computer Tomography-Guided Percutaneous Celiac Plexus Neurolysis for Pain Relief in Abdominal Malignancy

Wei-Yuan Cheng, Jen-Tsung Yang, Kuo-Tai Chen, Chia-Hao Chang and Ming-Hsueh Lee*

Background: Celiac ganglion block has been adapted for abdominal pain management for decades with substantial effectiveness. Localization of celiac ganglion or plexus is to be performed during surgery. Our study aims to disclose the effectiveness and precision of Intraoperative Computer Tomography-guided Percutaneous Celiac Plexus Neurolysis (iCT-PCPN) for patients with abdominal pain related to peritoneal carcinomatosis.

Methods: From January 2013 to December 2017, we completed iCT-PCPN for patients with peritoneal carcinomatosis-related pain. Chemolytic agents of phenol or alcohol were used for ganglion neurolysis. We have compared Numeric Rating Scale (NRS) and morphine dosage pre-operatively and post-operatively.

Results: Fourteen patients were included and 4 patients excluded. A statistical decrease of NRS was observed (median of the basal NRS 10 (Q1=9, Q3=10) compared with median NRS 3 (Q1=2, Q3=5) at 1 day, p<0.005, and median NRS 5 (Q1=4, Q3=6) at 28 days, p<0.005). The dosage of morphine administered did not increase significantly after iCT-PCPN (p>0.05). This indicates that iCT-PCPN could provide effective pain management for peritoneal carcinomatosis and decrease the use of morphine and its side effects.

Conclusion: Cancer-related peritoneal carcinomatosis is an ongoing process. We find that the patients may benefit from the procedure of iCT-PCPN by its precision, effective pain relief, and less complication arises from high dose of opioids. Therefore, patients with peritoneal carcinomatosis could have better quality of life during hospice care.