Effect of Patient Position on Computerized Tomography Guided Celiac Trunk Neurolysis

Mansoura University34 enrolled

Overview

Computerized tomography-guided Celiac plexus neurolysis has become a popular technique. As, it has Cross-section imaging system to avoids anatomic structures injury, it has high density resolution that clearly display the retro-peritoneal anatomic structures ,it allow an optimal puncture site selection and measured the angle and depth of the needle insertion accurately with display the range of the neurolytic agent diffusion

The aim of this study was to evaluate analgesic efficacy of a computerized tomography guided left lateral antero-crural approach near the origin of celiac trunk with patients position on their right side immediately after the procedure using a single needle injection technique for upper abdominal malignancy compared with the classic 2 needle posterior antero-crural injection technique and possible complications. All patients will take thin computerized tomography section in the axial plane to detect the site of celiac plexus and coronal plane for correct site for needle placement. Computerized tomography slices thickness will be from 3 mm at 5mm interval through all the abdominal and lower thoracic area. The celiac and superior mesenteric arteries will be identified after contrast injection. When an ideal needle position and tip were confirmed, the stylet was removed and aspiration was performed to ensure that there was no blood is withdrawn. A volume of 3 ml of lidocaine mixed with contrast was injected to confirm the position, after injection another cut has been taken to show the spread of contrast freely in the retro-peritoneal space around the celiac plexus and the aorta. After confirmation, that contrast was injected to surround the artery and make sure that there was no dorsal spread to avoid injury to somatic nerves. Also to make sure that there was no spread to the renal pelvis , injection of phenol 10% mixed with contrast through needle

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

SINGLE

Enrollment

Conditions

Upper Abdominal Malignancy

Interventions

Double needle celiac neurolysis (DNCN)DEVICE

CT guided celiac neurolysis will be performed using 2 needles inserted on each sides of aorta where patient was positioned in prone position

Single needle celiac neurolysis (SNCN)DEVICE

CT guided celiac neurolysis will be performed through advancing a single needle to justfront of the aorta near the origin of celiac trunk where patient placed in lateral position

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with gastric carcinoma * Patients with hepato-biliary-pancreatic cancer * Patients with colonic malignancy * Patients with peritoneal metastasis * Patients with extensive hepatic metastasis * Patients having intractable pain to opioids and other analgesics. * Patients experienced adverse effects to opioids or other analgesics. * Patients experienced improved intractable pain after diagnostic celiac plexus block Exclusion Criteria: * Patient's refusal * Patients with bleeding tendency * Patients with coagulopathy * Patients who were benefited from oral analgesics with no serious side effects * Patients with significant cardiac diseases * Patients with organ failure * Patients with distant vertebral metastasis * Evidence of local infection at the puncture site * Patients who did not experience improved pain after receiving a diagnostic celiac plexus block

Locations (1)

Mansoura University Cancer Institute

Al Mansurah, DK, Egypt

Outcomes

Primary Outcomes

Failure rate of patients positioning

Positioning failure means failure to put patient in prone or lateral position

Time frame: For 5 min before needle insertion

Secondary Outcomes

Time to achieve analgesia

Time to achieve pain score less than 3

Time frame: for one hour after performing the procedure

Failure of block

Failure of block is defined as patient having pain visual analogue scale greater than 3

Time frame: For 1 week after performing the procedure

Data from ClinicalTrials.gov

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