The Effectiveness of Repeat Celiac Plexus Neurolysis for Pancreatic Cancer: A Pilot Study

Authors

  • Kai McGreevy MD,

    1. Departments of Anesthesiology and Critical Care Medicine & Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Robert W. Hurley MD, PhD,

    1. Departments of Anesthesiology, Neurology and Orthopedic Surgery, University of Florida College of Medicine, Gainesville, Florida
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  • Michael A. Erdek MD,

    1. Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Musa M. Aner MD,

    1. Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Sean Li MD,

    1. Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Steven P. Cohen MD

    1. Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, Maryland
    2. Uniformed Services, University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
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Address correspondence and reprint requests to: Steven P. Cohen, MD, Division of Pain Medicine, Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, 550 North Broadway, Suite 301, Baltimore, MD 21205.
and Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, U.S.A. E-mail: scohen40@jhmi.edu

Abstract

Background:  Celiac plexus neurolysis (CPN) is an effective but temporary management tool for pancreatic cancer pain (PCP). Clinical studies have shown the duration of benefit with initial CPN to be apaproximately 3 months. When pain recurs, CPN may be repeated, but the outcomes for repeat CPN are not well established. The objective of this study is to determine the success rate and duration of relief following repeat celiac plexus neurolysis (rCPN) for PCP.

Methods:  Patients who underwent rCPN were identified from a database and their records reviewed. Responses of rCPN were then compared with iCPN for success rates and duration of relief. Success was defined as ≥ 50% pain relief lasting ≥ 1 month.

Results:  Overall, there were 24 rCPN performed. The success rate decreased from 67% after initial CPN to 29% following rCPN (P = 0.13). The mean duration of pain relief decreased in parallel from 3.4 months (iCPN) to 1.6 months (rCPN) (P = 0.03). Among those who had a successful rCPN, 2.9 months elapsed from iCPN to rCPN, with disease progression noted in 29%. In those who failed rCPN, 7.8 months elapsed, with disease progression apapreciated in 71% of cases.

Conclusions:  rCPN does not provide as much pain relief as iCPN. Disease progression as detailed on imaging appears to be a major factor in the limitations of rCPN. Further prospective studies are warranted to confirm these results and investigate the utility of rCPN.

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