Yan, B.M., & Myers, R.P. (2007). Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. The American Journal of Gastroenterology, 102(2), 430–438.

To compare the efficacy and safety of neurolytic celiac plexus blockade (NCPB) to the efficacy and safety of standard treatment of patients with unresectable pancreatic cancer

• Databases searched were Ovid, PubMed, MEDLINE, EMBASE, HealthSTAR, and the Cochrane Library. In addition, investigators performed manual searches of revelant materials. The date range searched was 1966–2005.
• Search keywords were celiac block, celiac plexus block, celiac plexus neurolysis, and splanchnicectomy.
• Studies were included if they
  • Were randomized controlled trials that compared NCPB to standard treatment.
  • Involved patients with pancreatic cancer.
• Studies were excluded if they involved NCPB as a treatment for conditions other than pancreatic cancer.

The search retrieved 491 articles. Authors described the data-abstraction procedures, quality-rating method, and meta-analysis procedures.

The sample included five randomized controlled trials whose results were published 1993–2004. The sample was composed of 302 patients.

• Effect of NCPB on pain as measured by a visual analog scale:
  • Weighted mean difference (WMD) at two weeks was not significantly different between control group and NCPB group.
  • At four weeks, NCPB showed a benefit, with WMD –0.50, 95% CI –0.85 through –0.15, p = 0.005.
  • At eight weeks with NCPB, WMD was –0.60, 95% CI 0.82 through –0.37, p < 0.00001.
• Effect of NCPB on opioid use:
  • At week 2, NCPB was associated with significantly lower opioid use (WMD –39.99 mg, 95% CI –60.08 through –19.91, p < 0.0001).
  • The difference in opioid intake increased over time, with the maximum reported difference at week 8: WMD –80.45 mg, 95% CI –134.66 through –26.24, p = 0.0004).
• Survival and quality of life (QoL): Authors observed no survival benefit with NCPB.  Two studies provided information about QoL. QoL decreased in a general pattern of decline in both treatment and control groups, with no significant difference between groups
• Adverse effects: In the NCPB group, constipation decreased significantly (RR 0.67, p = 0.01). The NCPB group showed a trend toward hypotension, but the trend was not statistically significant.

Compared with standard treatment, NCPB was associated with significant improvement in pain. Although the average change in pain score was small, the change was accompanied by a significant reduction in opioid use for pain control. The durability of NCPB impact is unknown. Effect seems to increase within eight weeks, but no data are available regarding use beyond that period. The study demonstrated no significant intergroup differences in the relative risk of adverse events.

Nurses should be aware that NCPB is an option for managing the pain of patients with unresectable pancreatic cancer. Awareness will enable nurses to advocate for the procedure when appropriate and to inform patients of potential treatment options. The duration of NCPB is unknown.