An Open Randomized Comparison of Clinical Effectiveness of Protocol-Driven Opioid Analgesia, Celiac Plexus Block or Thoracoscopic Splanchnicectomy for Pain Management in Patients with Pancreatic and Other Abdominal MalignanciesJohnson C.D. · Berry D.P. · Harris S. · Pickering R.M. · Davis C. · George S. · Imrie C.W. · Neoptolemos J.P. · Sutton R.
aSouthampton General Hospital, Southampton, bLeicester General Hospital, Leicester, cUniversity of Southampton, Southampton, dGlasgow Royal Infirmary, Glasgow, and eRoyal Liverpool University Hospital, Liverpool, UK
In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM). Methods: Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB, or MM+TS. Randomization was stratified by treatment centre, tumour type and previous opioid medication. The primary endpoint was pain relief at 2 months. Results: 65 patients (58 pancreas cancer) were randomized, 18 withdrew or died within 2 months. Effective pain relief was achieved in only one third of subjects at 2 weeks, and just under half at 2 months (MM: 6/19 and 5/12 evaluable patients; CPB: 5/14 and 5/9; TS 4/14 and 4/11). There were no significant differences between the groups in pain scores or opioid consumption, and there was no correlation between continued use of opioids and effective pain relief. Discussion: Previous randomized studies have shown small differences in pain scores, but no difference in opioid consumption and quality of life. The absence of any benefit from interventions in the present study questions their value.
Colin D. Johnson
University Surgical Unit (816), Southampton General Hospital
Tremona Road, SO16 6YD Southampton (UK)
Tel. +44 23 8079 6146, Fax +44 23 8079 4020
Data Safety Monitoring Committee: D. Machin; A. Andren-Sandberg, Karolinska; N. Campkin, Queen Alexandra Hospital, Portsmouth. Chair of Trial Steering Committee: M. Bennett, St Gemma’s Hospice, Leeds.
Received: May 21, 2008
Accepted after revision: January 23, 2009
Published online: January 15, 2010
Number of Print Pages : 9
Number of Figures : 3, Number of Tables : 5, Number of References : 23
Additional supplementary material is available online - Number of Parts : 1
Vol. 9, No. 6, Year 2009 (Cover Date: April 2010)
Journal Editor: Urrutia R. (Rochester, Minn.)
ISSN: 1424-3903 (Print), eISSN: 1424-3911 (Online)
For additional information: http://www.karger.com/PAN