After enrolment, patients were randomly assigned to two groups by means of a lottery procedure, whereby each patient blindly chose one of two labelled slips, resulting in group assignment to receive. Group A patients were subjected to CT-guided celiac plexus neurolysis, and Group B patients to standard pharmacotherapy for managing the pain over a period of four weeks. CT-guided celiac plexus neurolysis under the supervision of the principal investigator, using local anaesthetic and absolute ethanol injection for neurolysis, was carried out using aseptic technique. Baseline demographic information, which included age, gender, nature of malignancy, and the duration of disease, was recorded using a predesigned proforma. Pain severity was measured by the Visual Analogue Scale (VAS), a recognised 0-10 scale where 0 = no pain to 10 indicating the worst imaginable pain, at baseline and after 4 weeks of treatment. The major outcome measure was the average pain score at four weeks in both groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
110
Under intermittent CT guidance, one or two 20-22-gauge Chiba needles are advanced via a posterior paravertebral approach to the anterolateral aspect of the aorta at the level of the celiac axis. Correct needle placement is confirmed by CT imaging and the injection of a small amount of nonionic contrast material to ensure appropriate spread and exclude intravascular or intrathecal positioning. Following negative aspiration for blood or cerebrospinal fluid, a test dose of local anesthetic (commonly 5-10 mL of 1% lidocaine) is administered to minimize procedural pain and assess for adverse effects. Subsequently, a neurolytic agent, typically 15-25 mL of 95-100% absolute alcohol or 6-10% phenol on each side depending on the technique used, is slowly injected under CT guidance to achieve circumferential spread around the celiac plexus. A final CT scan is obtained to document the distribution of the neurolytic solution and exclude immediate complications.
Patients will be provided with the standard oral and intravenous analgesics such as fentanyl and oxycodone.
Mayo Hospital
Lahore, Punjab Province, Pakistan
Average pain score at baseline and after 4 weeks of treatment
Pain severity was measured by the Visual Analogue Scale (VAS), a recognized 0-10 scale where zero is equivalent to no pain and 10 indicates the worst imaginable pain, at baseline and after 4 weeks of treatment.
Time frame: Baseline to 4 weeks
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