Intraoperative Versus CT Guided Celiac Plexus Neurolysis in Unresectable Pancreatic Cancer
Pain, Chronic
About this trial
This is an interventional supportive care trial for Pain, Chronic
Eligibility Criteria
Inclusion Criteria:
- Adult patients suffering of pain from pancreatic cancer with baseline VAS≥5, scheduled for surgical assessment
- patients proven histololgically to be unresectable
- patients undergoing either biopsy or bypass surgery
Exclusion Criteria:
- patient with resectable tumour will be excluded.
- Patient with coagulopathy.
- patient with aortic aneurysm.
- patient with any disease contraindicating any sympathetic blockade as advanced cardiac disease .
Sites / Locations
- Mansoura university , gastrointestinal surgery center
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
intraoperative group (IOCPN group)
CT group (CTCPN group)
Intraoperative celiac plexus neurolysis Before closure of the abdomen the surgeon will expose the aorta at the level of the celiac trunk.With the stomach retracted inferiorly, the index and second finger of the surgeon's left hand straddle the aorta with the index finger placed on the splenic artery and the second finger on the common hepatic artery. we will use of a 20- gauge spinal needle (in contrast to the usual short intravenous needle) allows better visualization and access to this area, especially in deep patients, while a 10 ml syringe permits the surgeon to control the injection with the right hand alone.(10) Twenty ml of 90 % alcohol, five ml lidocaine 2%, five mg dexamethasone will be injected in each side of the aorta after aspiration to exclude intravascular or subarachnoid injection.
CT guided celiac plexus neurolysis After one week of the operation and the patient completely awake, the patient will be transferred to CT lab. The procedure will be done after attachment of basic monitors and transfusion of 500 ml saline in 20 G cannula before starting the procedure and the patient will be given 5 mg midazolam as a sedation. The procedure will be done by anesthetist and radiologist who had a good experience in celiac plexus neurolysis. In our study we will use the classic posterior bilateral approach. The patient will be in the prone position. After sterilization of the back by chlorohixidine 10 % , subcutaneous injection of 5 ml lidocaine as a local anaesthesia until a wheel will be formed then the procedure will be done. We will use 20 G Chiba needle under guidance of CT. Twenty ml of 95% alcohol , five ml lidocaine 2 % and five mg dexamethasone in each side of the aorta after aspiaration to exclude intravascular injection and subarachnoid injection