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Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain

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Abstract

Background

Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use.

Patients and Methods

Fifty patients divided in two groups with locally advanced pancreatic cancer-associated abdominal pain underwent endoscopic ultrasound (EUS)-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second. Patients scored their pain according to the Numeric Rating Scale (NRS-11) before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure.

Results

The study has included 50 patient in two groups. There was no significant difference between the two groups as regards medical, laboratory, or tumor characters. The median pain score decreases from 8.32 ± 0.75 before the procedure to 3.75 ± 3.72 24 week after the procedure in group 1 and from 8.08 ± 0.86 before to 1.67 ± 2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks. There was no statistically significant difference between the two groups as regards the median survival time.

Conclusion

The addition of dexmedetomidine to bupivacaine 0.5% in EUS-CPN demonstrated beneficial effects as regards the degree and duration of pain relieve with negligible effect on the patient survival.

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Data Availability

Available at the data archive at the Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Egypt.

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Acknowledgments

The authors would like to thank all patients who participated in the study.

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Authors and Affiliations

  1. Department of Internal Medicine, Hepatology & Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ahmed Abdel Ghafar Saleh, Ahmed Sultan, Mohamed A. Hammouda & Ahmed Shawki

  2. Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Ahmed Abdel Ghafar Saleh

  3. Department of Surgical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mohamed Abd El Ghaffar

Authors
  1. Ahmed Abdel Ghafar Saleh
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  2. Ahmed Sultan
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  3. Mohamed A. Hammouda
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  5. Mohamed Abd El Ghaffar
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Contributions

Ahmed Abdel Ghafar: choosing idea, patient examination, writing, reviewing

Ahmed sultan: patient examination, writing, reviewing

Mohamed Hammouda: software, reviewing

Ahmed Shawki: reviewing

Mohamed Abd El Ghaffar: patient referral

All authors have read and approved the manuscript.

Corresponding author

Correspondence to Ahmed Abdel Ghafar Saleh.

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Competing Interests

The authors declare that they have no conflicts of interest.

Ethics Approval and Consent to Participate

Written consents from patients participated in the study or from their families were obtained and approved by the Mansoura Medical Ethics Committee (MMEC) of Faculty of Medicine.

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Saleh, A.A.G., Sultan, A., Hammouda, M.A. et al. Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain. J Gastrointest Canc 52, 682–689 (2021). https://doi.org/10.1007/s12029-020-00449-1

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  • DOI: https://doi.org/10.1007/s12029-020-00449-1

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