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Celiac plexus block for pancreatic cancer pain in adults

  • Review
  • Intervention




Pancreatic cancer causes severe pain in 50 to 70% of patients and is often difficult to treat. Celiac plexus block (CPB) is thought to be a safe and effective technique for reducing the severity of pain.


To determine the efficacy and safety of celiac plexus neurolysis in reducing pancreatic cancer pain, and to identify adverse effects and differences in efficacy between the different techniques.

Search methods

We searched Cochrane CENTRAL, MEDLINE, GATEWAY and EMBASE from 1990 to December 2010.

Selection criteria

Randomised controlled trials (RCTs) of CPB by the percutaneous approach or endoscopic ultrasonography (EUS)-guided neurolysis in adults with pancreatic cancer at any stage, with a minimum of four weeks follow-up.

Data collection and analysis

We recorded details of study design, participants, disease, setting, outcome assessors, pain intensity (visual analogue scale (VAS)) and methods of calculation.

Main results

The search identified 102 potentially eligible studies. Judged from the information in the title and abstract six of these concerning the percutaneous block, involving 358 participants, fulfilled the inclusion criteria and were included in the review. All were RCTs in which the participants were followed for at least four weeks. We excluded studies published only as abstracts. We identified one RCT comparing EUS-guided or computed tomography (CT) -guided CPB but its aim was to assess efficacy in controlling chronic abdominal pain associated with chronic pancreatitis rather than pancreatic cancer, so it was excluded.

For pain (VAS) at four weeks the mean difference was -0.42 in favour of CPB (95% confidence interval (CI) -0.70 to - 0.13, P = 0.004, fixed-effect model). At eight weeks the mean difference was -0.44 (95% CI -0.89 to - 0.01, random-effects model). At eight weeks there was significant heterogeneity (I2 = 89%).

Opioid consumption was significantly lower in the CPB group than the control group (P < 0.00001). 

Authors' conclusions

Although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients. Further studies and RCTs are recommended to demonstrate the potential efficacy of a less invasive technique under EUS guidance.








Cochrane CENTRAL、MEDLINE、GATEWAY、EMBASEを1990年から2010年12月まで検索した。






検索により、適格の可能性がある102件の研究を同定した。標題および抄録の情報から判断して、102件のうち、358例の参加者を対象にした経皮的ブロックに関する6件の研究が選択基準に合致したため、レビュー対象として選択した。研究はすべて、参加者を4週間以上にわたって追跡したRCTであった。抄録のみが発表されている研究は除外した。EUS下CPBまたはコンピュータ断層撮影法(CT)下CPBと比較した1件のRCTを同定したが、膵癌ではなく慢性膵炎による慢性腹痛の管理における有効性を評価することが試験の目的であったため、除外した。4週目時点の疼痛(VAS)については、CPBに優位性があり、平均差は-0.42[95%信頼区間(CI)-0.70~-0.13、P=0.004、固定効果モデル]であった。8週目時点の平均差は-0.44(95%CI -0.89~-0.01、ランダム効果モデル)。8週目時点では、有意な異質性が認められた(I2 = 89%)。CPB群は対照群に比較してオピオイドの消費量が有意に低かった(P < 0.00001)。




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Plain language summary

Celiac plexus block (CPB) in patients with unresectable pancreatic cancer-related pain

Abdominal pain is a major symptom in patients with inoperable pancreatic cancer and is often difficult to treat. Celiac plexus block (CPB) is a safe and effective method for reducing this pain. It involves the chemical destruction of the nerve fibres that convey pain from the abdomen to the brain. We searched for studies comparing CPB with standard analgesic therapy in patients with inoperable pancreatic cancer. We were interested in the primary outcome of pain, measured on a visual analogue scale (VAS). We also looked at the amount of opioid (morphine-like drugs) patients took (opioid consumption) and adverse effects of the treatment. Six studies (358 participants) comparing CPB with standard therapy (painkillers) met our inclusion criteria. At four weeks pain scores were significantly lower in the CPB group. Opioid consumption was also significantly lower than in the control group. The main adverse effects were diarrhoea or constipation (this symptom was significantly more likely in the control group, where opioid consumption was higher). Endoscopic ultrasonography (EUS)-guided CPB is becoming popular as a minimally invasive technique that has fewer risks, but we were not able to find any RCTs assessing this method (current medical literature on this subject is limited to studies without control groups). Although the data on EUS-guided CPB and pain control are promising, we await rigorously designed RCTs that may validate these findings. We conclude that, although statistical evidence is minimal for the superiority of pain relief over analgesic therapy, the fact that CPB causes fewer adverse effects than opioids is important for patients.