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Volume 12 Issue 3 ( July-September ) 2023

Original Articles

Role of Neurolytic Celiac plexus block in palliative cancer care: A Prospective Non-randomized comparative study
Dr. Preeti Sharma, Dr . Akshit Kumar, Dr. Sheikh Zulfikar Ali, Dr. Tariq Ahmed Gojwari

Background: Neurolytic celiac plexus block (NCPB) is used for managing the refractory abdominal pain that originates from the upper abdominal viscera. It involves Injecting a neurolytic medication around the celiac artery destroying the function of the celiac plexus, interrupting the pain pathway and thus reducing the intensity of cancer pain. Materials and methods: This prospective non-randomized study was conducted by the Department of Anesthesia, SKIMS, J&K in collaboration with the Department of Radiodiagnosis and the artment of medical oncology. Patients with pancreatic head and Gall bladder cancer with clinically mptomatic pain who met the inclusion/exclusion criteria were finally selected for the study. Out of the selected patients, two groups were made, one who received the Intervention (NCPB) and another group who received conservative pain management (Oral Morphine, Fentanyl transdermal patch and NSAIDs) Out of 64 patients selected, 29 were treated by NCPB and 35 were treated by conservative management. These patients were followed up on the 15th, 30th, 60th and 90th day to record the Visual analog pain scores (VAS) and any complications related to the procedure. Results: VAS scores in the intervention decreases group from (9.09±0.53) to (3.09 ± 0.52) on the 15th day to 3.10±0.67 on the 30th day to 3.27±1.00 on the 60th day and 3.90±0.83 at 90th day. VAS scores also decrease in the conservative group from 9.6±0.59 to 6.60±0.47 on the 15th day to 6.95±0.99 on the 30th day to 6.5±1.29 on the 60th day and from 7.45±1.42 at 90th day. However, the p-values obtained at all observation points (15th, 30th60th and 90th day) indicate a statistically significant difference between the two groups on the measure of pain. This suggests more pain relief in the intervention group. Both groups show a significant change (p-value <0.05) compared to baseline, but the maximum pain alleviation was noted in the first 15 days in both groups which was maintained after 90 days. The intervention group showed a steep fall (- 6 points) in VAS as compared to a gradual decrease (-3 points) in the conservative group at the 15th-day follow-up, concluding that conservative treatment has a slower effect on pain relief compared with the early response after celiac plexus block. Conclusion: NCPB provides early and significant pain improvement in pancreatic head and gall bladder cancer pain in comparison to conservative management.

 
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