Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis

Comparing the Effects of Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis for Non-pancreatic Upper Intra-abdominal Cancer Pain: a Prospective Randomized Study

Pain is prevalent among patients with gastrointestinal cancers. Standard procedures such as coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases. Meanwhile, splanchnic nerve neurolysis (SNN) as an alternative to CPN is more effective for cancer pain relief.

Although previous studies investigating the role of CPN/SNN mainly focus on pancreatic cancer cases, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.

Pain is prevalent among patients with gastrointestinal cancers. There is abundant evidence that coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases while the evidence for other upper abdominal cancer pain is less robust but emerging. Meanwhile, there is an increasing interest in utilising splanchnic nerve neurolysis (SNN) as an alternative to CPN for cancer pain relief.

Although previous studies investigating the role of CPN/SNN involved heterogenous types of intra-abdominal malignancies, majority of cases were pancreatic cancer. Therefore, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.

Inclusion Criteria:

• Age>=18
• Diagnosis of unresectable intra-abdominal cancer
• Visceral pain attributable to the cancer with NRS >= 4
• Able to understand instructions, give consent, complete questionnaires

Exclusion Criteria:

• Primary pancreatic cancer or metastatic disease involving pancreas
• Gross celiac axis distortion identified on imaging
• Acute abdomen condition eg. Intraabdominal sepsis, tumor rupture
• Other non-cancer causes attributable to the pain
• Gross ascites
• Previous coeliac plexus or splanchnic nerve neurolysis
• Contraindications to neurolytic procedures eg. Bleeding tendency; local or systemic infections; allergic to local anesthetics, contrast or alcohol; intestinal obstruction; anatomical distortion along needle trajectory
• Patients believed to be inappropriate for study by investigators