Abstract ID: A13

Abstract Title: Analgesic efficiency of the celiac plexus versus opioid therapy in cancer patients

Poster Type: Discussion


ABSTRACT BODY


Introduction
When it comes to managing cancer pain, the World Health Organization (WHO) has implemented an analgesic ladder, which recommends the use of potent opioid analgesics for the treatment of severe pain (1). Orally administered morphine is the drug of choice for such purposes. However, side-effects play an important role in the success or failure of analgesic therapy in patients (2).
Neurolytic celiac plexus block (NCPB) is an analgesic technique used for cancer pain in the upper abdomen (figure 1). The analgesic efficiency of the NCPB has been well documented (3). The rate of success with good to excellent pain relief ranges between 70-90% of the patients.

Objective
To compare the analgesic efficiency between systemic opioid therapy and NCPB in pancreatic cancer pain.

Method
During a five year period (November 1998 - November 2003) clinical files were registered from among the patients with pancreatic cancer who were referred to the pain clinic and Palliative Care Unit. Two groups were organized. Group 1 included those patients to whom NCPB was administered. Group 2 included those patients to whom an analgesic therapy only with systemic opioids was administered.
The pain intensity measured using the Visual Analogue Scale (VAS) in the files was registered at the beginning and throughout the course of the disease for which the patients were being attended at the Pain Clinic and Palliative Care Unit. The initial and final mean VAS score was calculated for each group. The mean dose of opioid analgesic for each group was calculated and converted into the equivalent for oral morphine. The mean VAS and amount of opioid analgesics used for each group was compared. Statistical analysis was made using the t test.

Results
Forty-one of the sixty-five files were excluded due to incomplete follow-up. Of the remaining files, 33.3% of the patients were treated with NCPB, while the remaining patients used only systemic opioids for pain control. The initial mean VAS score for each group was 7.75 ± 1.6 and 6.37± 2.55 respectively. At the end of the follow-up, the VAS score for each group was 3.1 (+/- 2.2) y 2.62 (+/- 1.92). There was no significant difference when the final VAS scores were compared (p=0.055). However there was no significant difference in the total amount of opioid consumption among both groups (p=0.07): 27.7 mg of oral morphine (+/- 25.7) for group 1 and 76.5 mg (+/- 70.1) for group 2 Figure 2.

Conclusion
There is no significant difference in the analgesic efficiency of NCPB and systemic opioid therapy in pancreatic cancer pain.
There is tendency towards a reduction in the amount of opioid consumption after an NCPB is performed for pain control.

Reference
(1) World Health Organization: Cancer Pain Relief: with a guide to opioid availability. WHO, Geneve 1996.
(2) Cherny N, Ripamonti C, Pereira J, et al: Strategies to manage the adverse effects of oral morphine: An evidence based report. J of Clin Oncol 2001; 19: 2542-2554.
(3) Wong G; Schroeder D, Carns P et al. Effect of Neurolytic Celiac Plexus Block on Pain Relief, Quality of Life, and Survival in Patients With Unresectable Pancreatic Cancer: A Randomized Controlled Trial. JAMA 2004; 291(9):1092-1099

ATTACHED FILES



A13_Figure 1.tif

A13_Figure 2.tif

Reg Anesth Pain Med 2004; 29(2):A13