Servicios Profesionales de Anestesiología yMedicina del Dolor

Centro Médico del NoroesteTijuana BC, México

V. Whizar-Lugo, F. Anzorena-Vallarino, R. Estrada-Coronado,C. Solar-Labastida, C. Segovia-García, J. Saldaña-Huerta

ONE NEEDLE TRANS-AORTIC AND RETROCRURAL NEUROLYTIC CELIAC ONE NEEDLE TRANS-AORTIC AND RETROCRURAL NEUROLYTIC CELIAC PLEXUS BLOCK FOR SEVERE UPPER ABDOMINAL CANCER PAINPLEXUS BLOCK FOR SEVERE UPPER ABDOMINAL CANCER PAIN

www.anestesia-dolor.orgvwhizar@anestesia-dolor.org

One One Needle,Trans-aortic and RetrocruralNeedle,Trans-aortic and RetrocruralCeliac Plexus NeurolysisCeliac Plexus NeurolysisAim of the study

• To investigate the usefulness of a single needle injection for a pre-aortic and retrocrural CPN in opioid resistant cancer pain patients, who have anatomy distortion

• To determine the pre-crural and retro-crural neurolytic spread

• To determine side effects and complications of this technique

Anatomy and Neurolytic Agent Diffusion

Celiac plexus neurolysis techniquesAccording with anatomical approaches

POSTERIOR APPROACH Retrocrural, Trans-crural, and Trans-aortic

ANTERIOR APPROACHTrans-gastric and Trans-hepatic

RETROCRURAL Standard

Two needless with posterior approach

PRECRURALPosterior approach

Trans-aorticTrans-crural

Anterior approachTrans-hepaticTrans-gastric

RETRO and PRECRURALPosterior approach

One needle technique

Celiac plexus neurolysis techniquesAccording with neddle placement

Analgesia (VAS) and % Opiod Reduction

R e s u l t s

Patients Type of cancer Pain (VAS) % opioid reduction

Follow-up

No Age Sex Initial Final Months

12 51.8 M 11 / F1 Pancreas 8.7±0.9 2.5±0.9 76.25% 1 - 12

2 50.5 M 1 / F1 Liver 8.0 2.0 97.5% 3 - 7

2 39 M 1 / F1 Gastric limphoma

9.0 2.0 77.5% 5 - 8

2 47.5 M 1 / F1 Stomach 9.0 2.0 95.0% 1 - 7

TOTAL 18

M 14 / 2 9.0±0.89 2.3±0.9 80.8% 1 - 12

Patients Pain (VAS) Cancer % opioid reduction

Follow-up

No Age Sex inicial final Months Dead

1 58 M 10 1 Pancreas 85 4 -

2 70 M 8 2 Pancreas 50 6 +

3 58 F 9 3 Stomach 90 7 +

4 35 M 10 2 Gastric limphoma 85 5 -

5 42 M 8 2 Pancreas 100 1 -

6 53 M 8 3 Liver 95 3 +

7 62 F 10 4 Pancreas 0 2 +

8 37 M 9 1 Stomach 100 1 -

9 55 M 8 3 Pancreas 90 4 -

10 43 M 10 3 Pancreas 90 8 +

11 51 M 9 3 Pancreas 100 3 -

12 39 M 9 2 Pancreas 80 4 +

13 48 F 8 1 Liver 100 7 +

14 52 M 8 3 Pancreas 70 4 +

15 39 M 9 3 Pancreas 80 7 +

16 43 F 8 2 Gastric limphoma 70 8 -

17 59 M 7 1 Pancreas 100 5 +

18 52 M 9 3 Pancreas 70 12 -

C o m p l i c a t i o n sC o m p l i c a t i o n s

MinorLocal pain n= 5 (-%)

Transitory diarrhea n= 4 (-%)

Arterial hypotension n= 2 (-%)

Severe none

TRANS-AORTIC AND RETROCRURALTRANS-AORTIC AND RETROCRURAL

C o n c l u s i o n s

1.This technique is usefull in patients with opioid resistant/side effects upper abdominal cancer pain, who have anatomy distortion

2. It is a safe, and easy procedure

3.No neuro-vascular complications were seen

4.Satisfactory analgesia was achieved

5.Total opioid intake was reduced

ONE NEEDLE CELIAC PLEXUS NEUROLYSIS