HOME
Return to Table of Contents
139 NEUROLYTIC CELIAC PLEXUS BLOCK FOR PAIN CONTROL IN UNRESECTABLE PANCREATIC CANCER: A META-ANALYSIS BM Yan, CL Nash, RP Myers BACKGROUND: Approximately 75% of patients with unresecetable pancreatic cancer (UPCa) have pain at diagnosis; therefore, a major focus of palliation is analgesia. Several randomized controlled trials (RCTs) have analyzed the efficacy of neurolytic celiac plexus block (NCPB) for patients with UPCa, but significant benefits have been difficult to establish partly due to small sample sizes. The aim of this meta-analysis was to examine the efficacy and safety of NCPB in UPCa.
Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta
METHODS: An electronic search was completed on OVID/PubMed Medline, EMBASE, HealthStar and the Cochrane Library (1966 through August 2005, limits: English, human, clinical trial) for RCTs comparing NCPB versus control (no treatment or sham NCPB) in patients with UPCa. Only full articles were included. The primary outcome was pain measured on a 10-pt visual analogue scale (VAS, 10= worst pain). Secondary outcomes included opioid usage, adverse effects, quality of life (QOL) and survival. All outcomes were assessed at two, four and eight weeks (W). Fixed-effect models were used due to the absence of significant heterogeneity (data not shown).
RESULTS: Five RCTs involving 302 patients (NCPB, n=147; control, n=155) met the inclusion criteria. The mean age was 61.0 yrs (SD 4.3); all patients had stage 3 or 4 UPCa. Compared with control, NCPB was associated with lower VAS scores for pain at 2W (weighted mean difference [WMD] -0.40; 95% CI -0.91 to 0.12), 4W (-0.50; 95% CI -0.85 to -0.15) and 8W (-0.60; 95% CI -0.82 to -0.37). Opioid usage (mg oral morphine/d) was also reduced at 2W (WMD -39.6; 95% CI -60.1 to -19.1), 4W (-49.4; 95% CI -75.8 to -23.1), and 8W (-85.9; 95% CI -144.0 to -27.9). NCPB was associated with a significant reduction in constipation (RR 0.67; 95% CI 0.49 to 0.91), but not other adverse events. No differences in survival were demonstrated (8W NCPB vs control: RR 1.08; 95% CI 0.96 to 1.22). QOL could not be adequately analyzed due to differences in outcome scales between studies.
CONCLUSIONS: Compared with standard treatment, NCPB is associated with improved pain control, and reduced narcotic usage and constipation in patients with UPCa. However, the clinical significance of these findings is minimal. QOL advantage of NCPB could not be demonstrated.