Ultrasound guided anterior approach coeliac plexus ethanol neurolysis for pain relief in gastric and pancreatic malignancy

Background and Aim: Chronic cancer pain is one of the major challenges of palliative care and it is prevalent in 80% of all the gastric and pancreatic malignancies. Adequate pain relief not only improves the drug compliance, but also alleviates depression among the cancer patients, thereby improving the quality of life. This study was carried out with the aim of evaluating the role of Coeliac Plexus ethanol Neurolysis (CPN) in pain relief among patients with gastric and pancreatic malignancy. Methods and materials: This is an uncontrolled before-and-after non randomized trial. This bedside procedure was done in an ICU in chronic pain management centre. Trial coeliac plexus block was done after identification of coeliac trunk using ultrasound and 15 cc of 1% xylocard was given. After 30 minutes, pain relief was assessed with Numerical Rating Scale for pain (NRS). Patient was then given 20ml of 60% ethanol. Pain relief was documented using NRS immediately at 24hours, 72 hours,1 week and 3 months. Statistical analysis was done using Statistical Package for the Social Sciences version (SPSS) version 16.0. Paired t test was used to analyze the difference between variables. Results: Our study shows statistically significant difference between pre-NRS and post immediate-NRS (mean 8.26±0.52 and 3.40 ±0.47)(P value < 0.0001) and significant decrease in NRS seen after 24 hours,72 hours,1 week and 3 months. Conclusion: USG guided anterior approach coeliac plexus ethanol neurolysis is effective in decreasing pain associated with gastric and pancreatic malignancy.