Effect of Coeliac Plexus Neurolysis for Pain Relief in Patients with Upper Abdominal Malignancy: A Retrospective

Observational Study
Dr. Anuj kumar Gautam, Dr Anurag Agarwal, Dr. Shivani Rastogi
Dr. RAM MANOHAR LOHIA INSTITUTE OF MEDICAL SCIENCES, LUCKNOW, U.P. 226010

❖ INTRODUCTION: ❖ PROCEDUREs:
Coeliac plexus neurolysis (CPN) is the chemical neurolysis of the In this study we did coeliac plexus neurolysis by TRANS-AORTIC APPROACH in
visceral afferent fibers that transmit pain from the upper all the patients under C-ARM fluoroscopic guidance using 15 ML of 75% alochol
abdominal viscera and is also recommended by the WHO Cancer
Pain Relief Ladder.
❖ ANATOMY AND INNERVATIONS:

❖ RESULTS:
Data from 94 patients regarding pain, quality of life and morphine equivalents
consumption were collected and analyzed in this retrospective study. Due to
higher mortality rates of advanced cancer origin diseases, complete follow-up
❖ DISCUSSIONS:
was limited to only 27 patients who were alive until the completion of 6 months
follow-up of the study whereas the data of rest of the patients (67 out of 94)
Advanced abdominal malignancies tends to change anatomical location of
was assessed until their demise.
coeliac plexus. As coeliac plexus which is comprised of Aortic, Renal, Coeliac
The mean VAS score of pre-op was 8.6 & was significantly reduced compared to and Superior hypogastric ganglions situated in pre-aortic fascia pre-
pre-op, P < 0.001 whereas, 4 th month onwards, VAS pain scores in the study dominantly, by using TRANS-AORTIC approach we reach in the pre-aortic
patients was statistically significantly comparable to 1 st 3 months VAS score. The fascia and deposit neurolytic agent. So this approach may overcome
pre-op mean morphine consumption was 60 mg/24 hours and reduction rates anatomical distortion due to abdominal malignancies.
of morphine consumption at follow-ups was significant compared to pre-op, P <
The differences observed in morphine consumption indicates, post-
0.001.
❖ OBSERVATIONS: procedure, satisfactory pain relief was achieved with the use of simple
Initially there was improved over-all quality of life of almost all cases. However, analgesics and weak opioids like tramadol. Frequent side effects of Oral
• VISUAL ANALOG SCALE (VAS) score many cases were in advanced stage, thereby assessment of quality of life was Morphine such as dry mouth, drowsiness, constipation, and nausea and
• QUALITY OF LIFE (QOL) vomiting can be reduced due to pain relief by CPN and resultant
affected due to advancement of the disease in later part of the follow-up
• CONSUMPTION OF MORPHINE downgrading of opioids .This has resulted in improved QOL in upper
• COMPLICATIONS, if any abdominal malignancy patients underwent CPN.