Current Treatment Options in Gastroenterology

, Volume 6, Issue 5, pp 375–379 | Cite as

Neurolytic approaches for the treatment of pain in patients with chronic pancreatitis

  • Manoop S. Bhutani
  • P. Jay Pasricha

Opinion statement

In large part, treatment options for patients with painful chronic pancreatitis remain empirical because of our limited understanding of the pathobiology of pancreatic pain. The procedures of neural block/ablation exemplify these limitations, which include the lack of a clear biologic rationale for various approaches, as well as unequivocal data on long-term outcomes and efficacy. Although the techniques themselves appear to be well established, controlled trials of various medical, endoscopic, radiologic, and surgical options to define the best treatment are clearly needed. In addition, the lack of uniform improvement with any technique underscores the need for applying a multidisciplinary approach to these patients, as should be the case for any chronic pain disorder.


Chronic Pancreatitis Bupivacaine Celiac Artery Celiac Plexus Celiac Plexus Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Mercadante S, Nicosia F: Celiac plexus block: a reappraisal. Regional Anesth Pain Med 1998, 23:37–48.CrossRefGoogle Scholar
  2. 2.
    Yuen TS, Ng KF, Tsui SL: Neurolytic celiac plexus block for visceral abdominal malignancy: is prior diagnostic block warranted. Anesth Intensive Care 2002, 30:442–448.Google Scholar
  3. 3.
    Pap A, Topa L, Berger Z, et al.: Pain relief and functional recovery after endoscopic interventions for chronic pancreatitis. Scand J Gastroenterology 1998, 33(suppl 228):98–106.CrossRefGoogle Scholar
  4. 4.
    Busch E, Athcison R: Steroid celiac plexus block for chronic pancreatitis. J Clin Anesth 1989, 1:431–433.PubMedCrossRefGoogle Scholar
  5. 5.
    Hanowell ST, Kennedy SF, MacNamara TE, et al.: Celiac plexus block: diagnostic and therapeutic applications in abdominal pain. South Med J 1980, 73:1330–1332.PubMedGoogle Scholar
  6. 6.
    Vranken JH, Zuurmond WW, Van Kemenade FJ, Dzoljic M: Neurohistopathological findings after a neurolytic celiac plexus block with alcohol in patients with pancreatic cancer pain. Acta Anesthesiol Scand 2002, 46:827–830.CrossRefGoogle Scholar
  7. 7.
    De Cicco M, Matovic M, Balestreri L, et al.: Single-needle celiac plexus block: is needle tip position critical in patients with no regional anatomic distortions? Anesthesiology 1997, 87:1301–1308.PubMedCrossRefGoogle Scholar
  8. 8.
    Hol PK, Kvarstein G, Viken O, et al.: MRI-guided celiac plexus block. J Magn Reson Imaging 2000, 12:562–564.PubMedCrossRefGoogle Scholar
  9. 9.
    Lillemoe KD, Cameron JL, Kaufman HS, et al.: Chemical spanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial. Ann Surg 1993, 217:447–457.PubMedCrossRefGoogle Scholar
  10. 10.
    Van Dongen RT, Crul BJ: Paraplegia following celiac plexus block. Anesthesia 1991, 46:862–863.CrossRefGoogle Scholar
  11. 11.
    Bell SN, Cole R, Roberts-Thomson IC: Coeliac plexus block for control of pain in chronic pancreatitis. BMJ 1980, 281:160.CrossRefGoogle Scholar
  12. 12.
    Leung JW, Bowen Wright J, Aveling W, et al.: Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis. Br J Surg 1983, 70:730–732.PubMedCrossRefGoogle Scholar
  13. 13.
    Owitz S, Koppulu S: Celiac plexus block: an overview. Mt Sinai J Med 1983, 50:486–490.PubMedGoogle Scholar
  14. 14.
    Wiersema MJ, Wiersema LM: Endosonography guided celiac plexus neurolysis. Gastrointest Endosc 1996, 44:656–662.PubMedCrossRefGoogle Scholar
  15. 15.
    Gunartanam NT, Sarma AV, Norton ID, et al.: A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc 2001, 54:316–324.CrossRefGoogle Scholar
  16. 16.
    Bhutani MS: Endoscopic ultrasound guided celiac plexus neurolysis. Visible Hum J Endosonography 2002, 1:issue 3. A recent review on the technical and practical aspects of EUS-guided celiac plexus block and neurolysis.Google Scholar
  17. 17.
    Wiersema MJ: Endosonography guided celiac plexus neurolysis. In Interventional Endoscopic Ultrasonography. Edited by Bhutani MS. Amsterdam: Harwood Academic Publishers; 1999:117–123.Google Scholar
  18. 18.
    Gress F, Schmitt C, Sherman S, et al.: Endoscopic ultrasound guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol 2001, 96:409–416. A large, single-center study of 90 chronic pancreatitis patients undergoing EUS-guided celiac block showing that most patients relapsed within 1 month of treatment.PubMedCrossRefGoogle Scholar
  19. 19.
    Levy MJ, Wiersema MJ: EUS-guided celiac plexus neurolysis and celiac plexus block. Gastrointest Endosc 2003, 57:923–930. A recent, comprehensive evidence-based review on the efficacy of celiac plexus block under EUS guidance.PubMedCrossRefGoogle Scholar
  20. 20.
    Leksowski K: Thoracoscopic splanchnicectomy for the relief of pain due to chronic pancreatitis. Surg Endosc 2001, 15:592–596.PubMedCrossRefGoogle Scholar
  21. 21.
    Bradley EL 3rd, Reynhout JA, Peer GL: Thoracoscopic splanchnicectomy for “small duct” chronic pancreatitis: case selection by differential epidural analgesia. J Gastrointest Surg 1998, 2:88–94.PubMedCrossRefGoogle Scholar
  22. 22.
    Moodley J, Singh B, Shaik AS, et al.: Thoracoscopic splanchnicectomy: pilot evaluation of a simple alternative for chronic pancreatic pain control. World J Surg 1999, 23:688–692.PubMedCrossRefGoogle Scholar
  23. 23.
    Buscher HC, Jansen JJ, van Goor H: Bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Scand J Gastroenterol 1999, 230(suppl):29–34.CrossRefGoogle Scholar
  24. 24.
    Buscher HC, Jansen JB, van Dongen R, et al.: Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Br J Surg 2002, 89:158–162.PubMedGoogle Scholar
  25. 25.
    Maher JW, Johnlin FC, Heitschusen D: Long-term followup of thoracoscopic splanchnicectomy for chronic pancreatitis pain. Surg Endosc 2001, 15:706–709.PubMedCrossRefGoogle Scholar
  26. 26.
    Howard TJ, Swofford JB, Wagner DL, et al.: Quality of life after bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis. J Gastrointest Surg 2002, 6:845–852.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Manoop S. Bhutani
    • 1
  • P. Jay Pasricha
    • 1
  1. 1.Division of Gastroenterology and HepatologyUniversity of Texas Medical BranchGalvestonUSA

Personalised recommendations