Opioid-Sparing Effect of Celiac Plexus Neurolysis in Palliative Care Patients with Upper Abdominal Cancer: A Single-Center Retrospective Case Series of Thirteen Patients.

PURPOSE: Whether celiac plexus neurolysis (CPN) retains opioid-sparing efficacy in palliative care patients receiving modern extended-release opioids remains uncertain after a recent randomized trial that reported no benefit. We describe fluoroscopy-guided CPN in such patients.

METHODS

Thirteen consecutive palliative care patients with unresectable or metastatic upper abdominal cancer (seven pancreatic, five hepatobiliary, one gastric) on strong opioid therapy underwent posterior fluoroscopy-guided CPN with absolute ethanol after a diagnostic lidocaine block. Daily oral morphine equivalent (OME) and Numeric Rating Scale (NRS) pain scores were recorded at baseline and 1, 2, and 4 weeks. Pain response was defined a priori as ≥30% NRS reduction.

RESULTS

Median age was 67 years, baseline median OME 86.5 mg/day (range, 15~215), and median NRS 6. Median OME decreased to 72, 60, and 57.5 mg/day at 1, 2, and 4 weeks (median reductions 46.5%, 26.7%, 43.5%; all P≤0.002), and median NRS improved to 3, 4, and 4 (all P≤0.001). A pain response was achieved in 8/13 (61.5%) at 1 week, 7/13 (53.8%) at 2 weeks, and 5/12 (41.7%) at 4 weeks. Opioid-related adverse events declined numerically (nausea, 7/13→3/12; constipation, 4→2; somnolence, 2→0; all McNemar P>0.10). No procedural complication occurred (0/13).

CONCLUSION

CPN was followed by reduction in opioid use and pain scores, with resolution of opioid-related symptoms and no complications. Although limited by the small sample size, these findings suggest a potential role for CPN in palliative care patients receiving extended-release opioids and warrant prospective investigation.