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Vol 3, No 4 (2004): Polish Palliative Medicine
Original articles
Published online: 2004-09-21
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The efficacy of intraoperative neurodestruction of the coeliac plexus using chemical neurolysis in patients with epigastric tumours

Tomasz Cieniawa, Jerzy Wordliczek, Jan Dobrogowski
Advances in Palliative Medicine 2004;3(4):343-352.

open access

Vol 3, No 4 (2004): Polish Palliative Medicine
Original articles
Published online: 2004-09-21

Abstract

Introduction. The insufficient analgesic effect obtained by using WHO pain management methods with respect to alleviating cancer pain directs researchers’ attention to invasive methods that could be used to supplement pharmacological ones or instead. One of such methods is the neurodestruction of the coeliac plexus (NCP) caused by the use of the chemical substances. The aim of the study was to assess the efficacy of the intraoperative coeliac plexus block in patients undergoing surgery due to the presence of epigastric tumour.
Materials and methods. Chemical neurolysis of the coeliac plexus was performed in 20 patients selected from a group of 86 patients suffering from severe pain who had a surgically confirmed presence of a tumour in the epigastrium, where no technical possibilities for tumour removal existed. The neurodestruction of the coeliac plexus was performed by using 40 ml of a local anesthetic - 0.5% bupivacaine mixed 1:1 with 98% alcohol. The efficacy of the block was monitored over 90 days using VAS, NRS and Melzack’s questionnaire.
Results. Following the neurodestruction of the coeliac plexus, 13 patients (65%) presented the significant reduction of pain symptoms. Throughout the three-month observation, virtually painless course of the disease was observed in 4 patients (20%). In 35% of cases (7 persons) the effect of the block was assessed as insufficient, whereas in 4 patients in this group no therapeutic effect was achieved. The mean VAS values for the entire group subjected to the chemical neurolysis (20 patients) were reduced from 5.81 to 2.98 (NRS from 6.00 to 3.01, respectively).
Conclusions. The efficacy of the intraoperative neurodestruction of the coeliac plexus performed in order to reduce pain in patients with epigastric tumours is comparable with transcutaneous techniques and may be an alternative to the pharmacological treatment.

Abstract

Introduction. The insufficient analgesic effect obtained by using WHO pain management methods with respect to alleviating cancer pain directs researchers’ attention to invasive methods that could be used to supplement pharmacological ones or instead. One of such methods is the neurodestruction of the coeliac plexus (NCP) caused by the use of the chemical substances. The aim of the study was to assess the efficacy of the intraoperative coeliac plexus block in patients undergoing surgery due to the presence of epigastric tumour.
Materials and methods. Chemical neurolysis of the coeliac plexus was performed in 20 patients selected from a group of 86 patients suffering from severe pain who had a surgically confirmed presence of a tumour in the epigastrium, where no technical possibilities for tumour removal existed. The neurodestruction of the coeliac plexus was performed by using 40 ml of a local anesthetic - 0.5% bupivacaine mixed 1:1 with 98% alcohol. The efficacy of the block was monitored over 90 days using VAS, NRS and Melzack’s questionnaire.
Results. Following the neurodestruction of the coeliac plexus, 13 patients (65%) presented the significant reduction of pain symptoms. Throughout the three-month observation, virtually painless course of the disease was observed in 4 patients (20%). In 35% of cases (7 persons) the effect of the block was assessed as insufficient, whereas in 4 patients in this group no therapeutic effect was achieved. The mean VAS values for the entire group subjected to the chemical neurolysis (20 patients) were reduced from 5.81 to 2.98 (NRS from 6.00 to 3.01, respectively).
Conclusions. The efficacy of the intraoperative neurodestruction of the coeliac plexus performed in order to reduce pain in patients with epigastric tumours is comparable with transcutaneous techniques and may be an alternative to the pharmacological treatment.
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Keywords

neurolysis; coeliac plexus; cancer pain

About this article
Title

The efficacy of intraoperative neurodestruction of the coeliac plexus using chemical neurolysis in patients with epigastric tumours

Journal

Advances in Palliative Medicine

Issue

Vol 3, No 4 (2004): Polish Palliative Medicine

Pages

343-352

Published online

2004-09-21

Bibliographic record

Advances in Palliative Medicine 2004;3(4):343-352.

Keywords

neurolysis
coeliac plexus
cancer pain

Authors

Tomasz Cieniawa
Jerzy Wordliczek
Jan Dobrogowski

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