Clinical trial: a randomized trial comparing fluoroscopy guided percutaneous technique vs. endoscopic ultrasound guided technique of coeliac plexus block for treatment of pain in chronic pancreatitis

• Published in: Alimentary pharmacology & therapeutics 2009-05, Vol.29 (9), p.979-984
• Main Authors: SANTOSH, D., LAKHTAKIA, S., GUPTA, R., REDDY, D. N., RAO, G. V., TANDAN, M., RAMCHANDANI, M., GUDA, N. M.
• Format: Article
• Language: English
• Subjects: Abdominal Pain - drug therapy; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents - therapeutic use; Autonomic Nerve Block - methods; Biological and medical sciences; Bupivacaine - therapeutic use; Celiac Plexus; Digestive system; Endoscopy; Female; Fluoroscopy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pain Measurement; Pancreatitis, Chronic - drug therapy; Pharmacology. Drug treatments; Treatment Outcome; Triamcinolone - therapeutic use; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2009.03963.x

Summary Background  Coeliac plexus block (CPB) is a management option for pain control in chronic pancreatitis. CPB is conventionally performed by percutaneous technique with fluoroscopic guidance (PCFG). Endoscopic ultrasound (EUS) is increasingly used for CPB as it offers a better visualization of the plexus. There are limited data comparing the two modalities. Aim  To compare the pain relief in chronic pancreatitis among patients undergoing CPB either by PCFG technique or by EUS guided technique. Methods  Chronic pancreatitis patients with abdominal pain requiring daily analgesics for more than 4 weeks were included. Fifty six consecutive patients (41 males, 15 females) participated in the study. EUSG‐CPB was performed in 27 and PCFG‐CPB in 29 patients. In both the groups, 10 mL of Bupivacaine (0.25%) and 3 mL of Triamcinolone (40 mg) were given on both sides of the coeliac artery through separate punctures. Results  Pre and post procedure pain scores were obtained using a 0‐10 visual analogue scale. Improvement in pain scores was seen in 70% of subjects undergoing EUS‐CPB and 30% in Percutaneous‐ block group (P = 0.044). Conclusions  EUS‐guided coeliac block appears to be better than PCFG‐CPB for controlling abdominal pain in patients with chronic pancreatitis.