![]() Preganglionic parasympathetic efferent fibers from the posterior vagal trunk are also found in the coeliac plexus. Next to the renal artery, the renal ganglia and the aoriticorenal ganglia are found. More caudally beneath the origin of the superior mesenteric artery, the superior mesenteric ganglion is located. The coeliac plexus comprises two big paired and many smaller ganglia: right and left from the origin of the coeliac trunk from the aorta, a left and right coeliac ganglion is located. The following nerves join the coeliac plexus: (1) preganglionic sympathetic efferent nerve fibers from the lower thoracic and upper lumbar ganglia (2) the end of the posterior vagal trunk of the esophageal plexus (3) the greater and lesser splanchnic nerve. It is located in the retroperitoneal fat, posterior to the pancreas and stomach, and separated posteriorly by the diaphragmatic crura. ![]() The coeliac plexus is located over the anterior and lateral surface of the aorta, next to the origin of the coeliac trunk and the superior mesenteric and renal arteries. The coeliac plexus is the largest autonomic plexus, composed of nerve fibers and ganglia, and because of its radial shape it is known as the solar plexus. Thus, percutaneous interventional techniques like CT-guided coeliac plexus blockade (CPB) or CT-guided coeliac plexus neurolysis (CPN) are commonly used pain management strategies to decrease pain, increase quality of life, and reduce opioid therapy. Despite the commonly known side effects of opioids, such as constipation, sedation, dependence, nausea, and respiratory depression or spasm of the sphincter of Oddi, CAP is in many cases refractory to opioid therapy, leading to a vicious circle of dose escalation and unwanted drug side effects. Treatment options as part of a multimodal approach, and standards for the management of cancer-related pain, range from medical treatment, typically opioids and centrally targeted pharmacotherapy, as well as interventional pain management procedures. Patients with uncontrolled CAP due to intra-abdominal malignancies develop breakthrough cancer pain (BTcP) in up to 70% of cases. Obstruction of hollow viscus, like biliary tract or intestine, or infiltration by cancer masses of the abdominal wall, retroperitoneal, or pelvic structures causes visceral pain due to mixed neuropathic and nociceptive mechanisms. As part of a multimodal approach, CPN should be considered as an earlier option for pain management in these patients.Ĭhronic abdominal pain (CAP) has a prevalence up to 50% in patients with intra-abdominal malignancies, and has a huge impact on patients’ quality of life and disability. In patients with intra-abdominal malignancy-related CAP, CPN is a safe and effective procedure which can provide long-lasting significant relief of background pain and BTcP. There was no correlation between median survival after CPN and pain outcomes. In 58% of patients pain medication was stable or was reduced after CPN 16% of patients complained about pain during the procedure no major complications occurred. The time frame from diagnosis to CPN was shorter in patients with pancreatic cancer compared to other intra-abdominal malignancies. Patients experienced a mean duration of pain prior to CPN of 330 (± 53) days. The time frame from diagnosis to CPN was 472 (± 416) days. Higher pain reduction after CPN led to longer-lasting pain relief. No difference in pain reduction in patients receiving a diagnostic CPB prior to CPN compared to patients without a diagnostic CPB was found. ![]() Higher pre-procedural pain intensity was correlated with higher pain reduction. Patients receiving repeated CPN showed higher individual pain reduction. CPN led to significant pain reduction and decreased BTcP intensity. ResultsĪ total of 84 procedures (24 CPB and 60 CPN) were performed on 52 patients 62% of these patients had pancreatic cancer. Patients with intra-abdominal malignancies who underwent CPB and/or CPN for pain control at the general hospital Klagenfurt am Wörthersee from 2010 to 2019 were enrolled. The aim of this study was to evaluate pain outcomes among patients with intra-abdominal malignancies who underwent CPB and/or CPN. As part of a multimodal approach, CT-guided coeliac plexus blockade (CPB) and CT-guided coeliac plexus neurolysis (CPN) are commonly used pain management strategies. Prevalence rates of chronic abdominal pain (CAP) and breakthrough cancer pain (BTcP) are high in patients with intra-abdominal malignancies.
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