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Vol. 9, No. 6, 2009
Issue release date: April 2010
Section title: Original Paper
Pancreatology 2009;9:755–763
(DOI:10.1159/000199441)

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 Malignancies

Johnson 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

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/21/2008
Accepted: 1/23/2009
Published online: 1/15/2010

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 5

ISSN: 1424-3903 (Print)
eISSN: 1424-3911 (Online)

For additional information: http://www.karger.com/PAN

Abstract

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.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/21/2008
Accepted: 1/23/2009
Published online: 1/15/2010

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 5

ISSN: 1424-3903 (Print)
eISSN: 1424-3911 (Online)

For additional information: http://www.karger.com/PAN


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