• Michael A Erdek, Daniel E Halpert, Marlís González Fernández, and Steven P Cohen.
• School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA. merdek@jhmi.edu
• Pain Med. 2010 Jan 1; 11 (1): 92-100.

ObjectiveTo assess demographic and clinical factors associated with celiac plexus neurolysis outcomes.DesignRetrospective clinical data analysis.SettingA tertiary care, academic medical center.PatientsForty-four patients with terminal visceral (mostly pancreatic) cancer who failed conservative measures. Interventions. Fifty celiac plexus alcohol neurolytic procedures done for pain control after a positive diagnostic block.Outcome MeasuresA successful treatment was predefined as >50% pain relief sustained for > or =1 month. The following variables were analyzed for their association with treatment outcome: age, gender, duration of pain, origin of tumor, opioid dose, type of radiological guidance used, single- vs double-needle approach, type of block (e.g., antero- vs retrocrural), immediate vs delayed neurolysis, volume of local anesthetic employed for both diagnostic and neurolytic blocks, and use of sedation.ResultsThose variables correlated with a positive outcome included lower opioid dose and the absence of sedation. Strong trends for a positive association with outcome were found for the use of computed tomography (vs fluoroscopy), and using <20 mL of local anesthetic for the diagnostic block.ConclusionsCeliac plexus neurolysis may provide intermediate pain relief to a significant percentage of cancer sufferers. Both careful selection of candidates based on clinical variables, and technical factors aimed at enhancing the specificity of blocks may lead to improved outcomes.

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