Celiac plexus neurolysis.
نویسندگان
چکیده
Pancreatic cancer is the tenth most common malignancy and the fourth cause of cancerrelated death in Western countries. Because 5year survival in referral centers is less than 30%, clinical management of most patients involves palliation of the symptoms of which 90% are weight loss, jaundice, and pain. While jaundice related to biliary obstruction can be palliated by means of endoscopic therapy or surgery, pancreatic pain is often difficult to control. Initial therapy with non-steroid antiinflammatory agents (NSAIDs) is often rapidly overwhelmed by pain and necessitates being associated with opioid administration. Although opioids effectively relieve pain, they are associated with many different collateral effects, such as dry mouth, constipation, nausea, vomiting, drowsiness and delirium, which can determine a great decrease in quality of life and may also impair the immune function. Pancreatic pain is also quite common in patients with chronic pancreatitis and, in this case, pain has a multifactorial etiology; for this reason, prolonged drug therapy is related to an increased risk of narcotic-dependence [1]. Celiac plexus neurolysis (CPN) is a chemical splanchnicectomy of the celiac plexus; its goal is to ablate the efferent nerve fibres which transmit pain from the intra-abdominal viscera. Although the terms “celiac plexus” and “splanchnic nerves” are often used interchangeably, these are anatomically distinct structures. The splanchnic nerves are located above the diaphragm (retro-crural) and are typically anterior to the 12th thoracic vertebra; on the other hand, the celiac plexus is situated below the diaphragm (ante-crural), surrounding the basis of the celiac trunk. This plexus is composed of a dense network of ganglia and interconnecting fibres (Figure 1).
منابع مشابه
Pearls & oy-sters: Acute spinal cord infarction following endoscopic ultrasound-guided celiac plexus neurolysis.
• Celiac plexus neurolysis (CPN)/celiac plexus block (CPB) is used to treat excruciating cancerrelated abdominal pain.1 • CPN is done via injecting 50%–100% alcohol into the celiac plexus, which is located under the diaphragm at the level of T12-L1 adjacent to the abdominal aorta and the take-off of the celiac trunk.2 • Endoscopic ultrasound guided neurolysis (EUS CPN) has been found to have 85...
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Introduction. Celiac plexus neurolysis is used in pain management of patients with advanced and unresectable pancreatic cancer. We retrospectively analyzed efficacy and safety of endoscopic ultrasound- (EUS-) guided celiac plexus neurolysis in patients treated in our unit. Methods. Twenty nine subjects with unresectable pancreatic cancer and severe pain despite pharmacological treatment underwe...
متن کاملAlleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis
The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus neurolysis, in which the celiac plexus is chem...
متن کاملFluoroscopy-guided Neurolytic Splanchnic Nerve Block for Intractable Pain from Upper Abdominal Malignancies in Patients with Distorted Celiac Axis Anatomy: An Effective Alternative to Celiac Plexus Neurolysis - A Retrospective Study
INTRODUCTION The pain from upper gastrointestinal malignancy leads to considerable morbidity. The celiac plexus and splanchnic nerve neurolysis are good therapeutic options. Although splanchnic nerve neurolysis less frequently performed, but it has an edge over celiac plexus as it can be performed in patients with altered celiac plexus anatomy by enlarged lymph nodes. METHODS The fluoroscopy-...
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عنوان ژورنال:
- JOP : Journal of the pancreas
دوره 5 4 شماره
صفحات -
تاریخ انتشار 2004