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European Radiology
Published in: European Radiology 8/2020

01-08-2020 | Ultrasound | Interventional

Contrast-enhanced ultrasound–guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience

Authors: Lu Wang, Man Lu, Xiaobo Wu, Xueqing Cheng, Tingting Li, Zirui Jiang, Yuping Shen, Ting Liu, Yue Ma

Published in: European Radiology | Issue 8/2020

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Abstract

Objectives

The purpose of this study was to determine the efficacy and safety of contrast-enhanced ultrasound (CEUS)–guided celiac plexus neurolysis (CPN) in patients with upper abdominal cancer pain.

Methods

Thirty-five patients with upper abdominal cancers tortured by intractable upper abdominal pain underwent CEUS-guided CPN with ethanol. The pain alleviation and opioid intake were observed and evaluated during a 3-month follow-up after CPN. The dispersion of alcohol around the aorta was evaluated on 3D-CEUS. Complications were assessed during CPN and at follow-up.

Results

All of the 35 patients’ CPN was successfully achieved. Pain relief was observed in 28 (80%), 20 (57.1%), 27 (77.1%), 20 (57.1%), and 10 (29.4%) patients immediately, 1 day, 1 month, 2 months, and 3 months after CPN, respectively. The agent dispersion around the aorta on CEUS images of 28 patients who showed pain relief was at least 90° of the circumference around the aorta. The median duration of pain alleviation was 2.7 months (95% confidence interval [CI], 2.5–2.9). Less than half of the patients had minor complications including irritant pain at the puncture site (8 of 35; 22.9%), diarrhea (4 of 35; 11.4%), nausea and vomiting (3 of 35; 8.6%), and post-procedural hypotension (1 of 35; 2.9%).

Conclusions

CEUS-guided CPN is a safe and effective method to alleviate refractory upper abdominal pain in patients with upper abdominal cancers. CEUS image allows the visualization of puncture path and observation of drug dispersion. The pain relief is relevant to the dispersion of neurolytic agent around the aorta.

Key Points

• CEUS-guided celiac plexus neurolysis (CPN) is feasible and easy.
• It allows direct visualization of the diffusion of the neurolytic agent in the retroperitoneal anatomic space.
• CEUS-guided CPN improves safety of CPN by clearly delineating the needle path.
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Metadata
Title
Contrast-enhanced ultrasound–guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience
Authors
Lu Wang
Man Lu
Xiaobo Wu
Xueqing Cheng
Tingting Li
Zirui Jiang
Yuping Shen
Ting Liu
Yue Ma
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06705-z

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