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This subject intends to explore the value of intraoperative celiac plexus block in postoperative acute pain management and its promoting effect on patients' rapid recovery during Whipple surgery through a randomized controlled trial.
This study is a single center, randomized, single-blind controlled study. After calculating the sample size, 66 subjects would be randomly assigned to nerve block group (NB group: local anesthetic injection at the target position) and blank control group (GC group: no celiac plexus block) according to the ratio of 1:1, in order to evaluate the effectiveness and safety of celiac plexus block (CPB) as a part of multimodal analgesia for postoperative pain management.
Anesthesia protocol: the standard anesthesia protocol for open Whipple surgery in our hospital was adopted.
Postoperative analgesia plan: before abdominal closure at the end of operation, The surgeon was instructed to perform a single celiac plexus block (CPB) under direct vision. Ropivacaine was injected into the target nerve in NB group, but no injection in GC group. After the operation, the anesthesiologist used ropivacaine to perform ultrasound-guided abdominal wall nerve block. When leaving the operating room, connect intravenous analgesia pump. Patients with subjective pain score of 3 or above can press. If the analgesia is insufficient, intravenous injection of dezocine can be added temporarily. The intravenous analgesia pump shall be withdrawn after 72 hours of use. If the analgesia pump is used up and is still needed, the anesthesiologist can evaluate and add medicine.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NB group | Experimental | Celiac plexus block (CPB) was added to the postoperative analgesia plan. CPB: the target nerve is located in the retroperitoneal space, embedded in the fat in front of the aorta, and distributed in a network along the anterolateral wall of the aorta, just at the beginning of the celiac trunk. During direct vision (anterior) block, first expose the upper edge of the pancreas, palpate the abdominal aorta and abdominal trunk, and palpate the pulsation of the common hepatic artery and splenic artery at the level of the abdominal trunk. Use a 25g 6cm puncture needle with an extension tube and a syringe pumped back by an assistant to form a negative pressure, then the needle is inserted into the fat on both sides of the abdominal aorta. If there is no blood or fluid outflow, slowly inject 10ml of 0.5% ropivacaine each side. After pulling out the needle, observe whether there is damage and bleeding. If necessary, use low-energy electrocoagulation to stop bleeding. |
|
| GC group | No Intervention | The same analgesic plan as the experimental group, except that CPB is not performed. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Celiac plexus block | Procedure | The surgeon is instructed to perform a single celiac plexus block under direct vision. 10ml 0.5% ropivacaine is injected into the nerve in both sides. |
| Measure | Description | Time Frame |
|---|---|---|
| Opioid consumption | Morphine equivalent | 72 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Press of the analgesic pump | Daily frequency of pump presses | Every 24 hours post-surgery for 72 hours |
| Time to first flatus | 72 hours after surgery |
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Inclusion Criteria:
Exclusion Criteria:
Withdrawal criteria:
Patients who underwent unplanned surgeries, required reintubation or a second surgery, received ICU care within three days post-surgery, died within two weeks post-surgery, or experienced any unexpected events were withdrawn from the study.
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| Name | Affiliation | Role |
|---|---|---|
| Minpu Li, Master | Second Affiliated Hospital, School of Medicine, Zhejiang University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Second Affiliated Hospital, School of Medicine, Zhejiang University | Hangzhou | Zhejiang | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40263988 | Derived | Li M, Fang L, Xing T, Wang C, Chen S, Yu S, Zhu J. A single-blind randomized controlled trial of celiac plexus block for analgesia after whipple surgery. BMC Anesthesiol. 2025 Apr 22;25(1):193. doi: 10.1186/s12871-025-03045-7. |
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Researchers whose proposed use of the data has been approved.
With publication
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D000077212 | Ropivacaine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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| Ropivacaine | Drug | Mixed solution for nerve block, made of 0.75% ropivacaine (Naropin, Astrazeneca AB) diluted in different proportions. |
|
| Length of postoperative hospitalization | After surgery to before discharge, up to 2 months |
| White blood cell count | Laboratory tests of white blood cell count (WBC) | At the end of surgery and 24 hours post-surgery |
| C-reactive protein | Laboratory tests of C-reactive protein (CRP) | At the end of surgery and 24 hours post-surgery |
| Erythrocyte sedimentation rate | Laboratory tests of erythrocyte sedimentation rate (ESR) | At the end of surgery and 24 hours post-surgery |
| Interleukin-6 | Laboratory tests of interleukin-6 (IL-6) | At the end of surgery and 24 hours post-surgery |
| Procalcitonin | Laboratory tests of procalcitonin (PCT) | At the end of surgery and 24 hours post-surgery |
| Pain scores | VAS (0 indicates no pain and score 10 indicates the most severe pain) | 6, 12, 24, 48, 72 hours after surgery |
| Cardiac index changes during celiac plexus block | Celiac plexus block (CPB) | Before and 5、10、20 minutes after CPB |
| Systemic vascular resistance index changes during celiac plexus block | Celiac plexus block (CPB) | Before and 5、10、20 minutes after CPB |
| Postoperative mean arterial pressure | Mean arterial pressure (MAP) | Every 12 hours post-surgery for 72 hours |
| Postoperative heart rate | Heart rate (HR) | Every 12 hours post-surgery for 72 hours |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D000588 |
| Amines |