LeBlanc, J.K., Al-Haddad, M., McHenry, L., Sherman, S., Juan, M., McGreevy, K., . . . DeWitt, J. (2011). A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: One injection or two? Gastrointestinal Endoscopy, 74(6), 1300–1307.doi: 10.1016/j.gie.2011.07.073
To compare the pain relief achieved by one injection of alcohol versus two injections of alcohol during endoscopic ultrasound–guided (EUS) celiac plexus neurolysis (CPN); to compare the safety associated with the one- and two-injection techniques; to determine the extent to which the number of injections affects the onset and duration of pain associated with pancreatic cancer
Each CPN procedure involved injecting 20 ml 0.75% bupivacaine and 10 ml 98% alcohol into either one or two sites at the celiac trunk. The total sample was composed of 50 patients. Investigators conducted follow-up interviews by telephone to evaluate onset and duration of pain relief and complications. Interviews occurred at 24 hours after the procedure and then weekly.
Prospective single-blinded randomized parallel-group study
Fifty patients were enrolled and randomized. Pain relief was observed in 37 patients (74%): 20 (69%) in the one-injection group and 17 (81%) in the two-injection group. Median onset of pain relief in both groups was one day. Median duration of pain relief in the one-injection and two-injection groups was 11 weeks and 14 weeks, respectively. Complete pain relief was achieved in four patients (8%), two in each group. No long-term complications occurred.
The two techniques were not associated with any significant difference in patients' experience of pain.
Authors observed no difference in the safety associated with the two techniques or the survival rate. Nurses would be justified in advocating for the single-injection technique, to minimize patients' discomfort.