Coeliac plexus neurolysis for upper abdominal malignancies using an anterior approach: review of the literature

  • Anju Ghai Pt BD Sharma Post Graduate Institute of Medical Sciences
  • Hamesh Bansal Pt BD Sharma Post Graduate Institute of Medical Sciences
  • Sarthak Wadhera Pt BD Sharma Post Graduate Institute of Medical Sciences
Keywords: coeliac plexus, coeliac plexus block, imaging modalities, neurolytic techniques, pancreatic pain, upper abdominal malignancy

Abstract

Background: Coeliac plexus neurolysis (CPN) helps to diminish pain arising from malignancy of upper abdominal viscera. Imaging modalities have increased the success rates by enhancing technical accuracy including fluoroscopy, computed tomography and ultrasound. Advancement in the imaging modalities used has helped in the accurate depiction of anatomy and position of the needle tip. Methods: In an anterior approach, the patient lies supine and the needle is inserted through the anterior abdominal wall into the retropancreatic space. The needle often traverses the stomach, liver or pancreas before reaching the coeliac plexus due to anatomical considerations. The literature has been reviewed regarding various imaging modalities using an anterior approach to coeliac plexus block with regard to success rate, improvement in pain scores, duration of pain relief and analgesic consumption. Results: Successful pain relief in abdominal malignancies with an anterior approach using various imaging modalities varies between 54% and 94% of patients. Following neurolysis, many patients can be weaned off opioids. This procedure improves quality of life and reduces the risk of drug-related side effects. The duration of pain relief after an anterior approach is six to eight weeks. Conclusion: The use of various imaging modalities in an anterior approach has improved the technical accuracy in reaching the coeliac plexus, thereby avoiding the needle piercing crucial structures and avoiding deposition of drug in the retrocrural space, thereby reducing the risk of neurological complications. Coeliac plexus neurolysis via an anterior approach using different imaging modalities does not completely abolish pain, rather it diminishes pain, helping to reduce opioid requirements and improving survival in patients with upper abdominal malignancy.

Author Biographies

Anju Ghai, Pt BD Sharma Post Graduate Institute of Medical Sciences
MD Anaesthesia Professor Department of Anaesthesiology, Pain and Intensive Care Pt BD Sharma Post Graduate Institute of Medical Sciences Rohtak
Hamesh Bansal, Pt BD Sharma Post Graduate Institute of Medical Sciences
MD Anaesthesia Medical Officer Department of Anaesthesiology, Pain and Intensive Care Pt BD Sharma Post Graduate Institute of Medical Sciences Rohtak
Sarthak Wadhera, Pt BD Sharma Post Graduate Institute of Medical Sciences
MBBS student Pt BD Sharma Post Graduate Institute of Medical Sciences Rohtak
Published
2015-05-25
Section
Research Articles