Arcidiacono, P.G., Calori, G., Carrara, S., McNicol, E.D., & Testoni, P. A. (2011). Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database of Systematic Reviews (Online), 3, CD007519.

To assess the efficacy and safety of celiac plexus neurolysis in reducing pancreatic cancer pain; to identify adverse effects and differences associated with various techniques of celiac plexus neurolysis

• Databases searched were Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Gateway, and EMBASE. In addition, investigators manually searched reference lists and the proceedings of relevant international professional groups.
• Search keywords were celiac plexus, nerve block, pancreatic cancer, and pain.
• Studies were included if they
  • Involved celiac plexus block implemented through a surgical approach or EUS.
  • Were randomized controlled trials that included a minimum follow-up of four weeks.
  • Were published in English.
  • Dealt with pain secondary to pancreatic cancer.
• Studies were excluded if they were reported in an abstract rather than a full article or if they dealt with pain due to chronic inflammation rather than pain relating to cancer of the pancreas.

The initial search retrieved 102 studies. Investigators reviewed the studies in terms of risk of bias. Investigators performed a meta-analysis on studies that they selected to include.

• The final sample of studies consisted of six studies involving 358 patients.
• Range of sample size, across studies, was 20–137.

• At four weeks, mean pain score difference according to a visual analog scale was –0.42 with 95% confidence interval (CI) –0.71 through –0.13 (p = 0.004) in favor of celiac block. At eight weeks, investigators noted significant heterogeneity.
• Opioid consumption was lower with celiac plexus block, with a mean difference at four weeks of –34.33 (95% CI –44.43 through –24.24, p < 0.00001).
• Adverse events were more likely to occur in control groups. The most common adverse events were diarrhea and constipation. These effects may have been associated with the higher opioid consumption of patients taking placebo.
• The number of studies was insufficient to allow researchers to evaluate the efficacy of different block implementations.

Celiac plexus block appears to be a safe and effective means of reducing bone pain associated with pancreatic cancer. Results show that celiac plexus block has a slight but statistically significant advantage over usual analgesic treatment. Investigators noted that the studies included in the analysis had some identified risk of bias. Three of the studies were blinded; three were not. The studies Arcidiacono et al. reviewed were the same studies that Yan and Myers reviewed in 2007.

Data are insufficient to allow researchers to evaluate the differences between CT-guided and posterior percutaneous celiac plexus block techniques.

Nurses should be aware of celiac plexus block as a means of pain management in patients with cancer of the pancreas. Nurses should advocate for the patient and inform him or her of potential treatment options. Findings of this meta-analysis are based on follow-up at four weeks, and results showed significant heterogeneity at eight weeks. This suggests that efficacy may not be sustainable over the long term. Further research, including long-term follow-up, is needed.