Korean J Pain.  2021 Oct;34(4):479-486. 10.3344/kjp.2021.34.4.479.

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study

• Kwon HJ
• Jang K
• Leem JG
• Shin JW
• Kim DH
• Choi SS

• KMID: 2520756
• DOI: http://doi.org/10.3344/kjp.2021.34.4.479

Abstract

Background
Prior studies have reported that 40%-90% of the patients with celiac plexus-mediated visceral pain benefit from the neurolytic celiac plexus block (NCPB), but the predictive factors of response to NCPB have not been evaluated extensively. This study aimed to identify the factors associated with the immediate analgesic effectiveness of NCPB in patients with intractable upper abdominal cancer-related pain.
Methods
A retrospective review was performed of 513 patients who underwent NCPB for upper abdominal cancer-related pain. Response to the procedure was defined as (1) a decrease of ≥ 50% or ≥ 4 points on the numerical rating scale (NRS) in pain intensity from the baseline without an increase in opioid requirement, or (2) a decrease of ≥ 30% or ≥ 2 points on the NRS from the baseline with simultaneously reduced opioid consumption after NCPB. Logistic regression analysis was performed to determine the factors associated with successful responses to NCPB.
Results
Among the 513 patients included in the analysis, 255 (49.8%) and 258 (50.2%) patients were in the non-responder and responder group after NCPB, respectively. Multivariable logistic regression analysis showed that diabetes (odds ratio [OR] = 0.644, P = 0.035), history of upper abdominal surgery (OR = 0.691, P = 0.040), and celiac metastasis (OR = 1.496, P = 0.039) were the independent factors associated with response to NCPB.
Conclusions
Celiac plexus metastases, absence of diabetes, and absence of prior upper abdominal surgery may be independently associated with better response to NCPB for upper abdominal cancer-related pain.

Keyword

Abdominal Pain; Analgesics; Cancer Pain; Celiac Plexus; Denervation; Logistic Models

Figure

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  Fig. 1 Fluoroscopic views of the final needle location and the contrast flow in neurolytic celiac plexus block. (A) Paravertebral approach. (B) Transdiscal retrocrural approach.

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  Fig. 2 Study flowchart. NCPB: neurolytic celiac plexus block.

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