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An open randomised comparison of clinical effectiveness of protocol-driven opioid analgesia, celiac plexus block or thoracoscopic splanchnicectomy for pain management in patients with pancreatic or other abdominal malignancies

Johnson, C.D., Berry, D.P., Harris, S., Pickering, R.M., Davis, C., George, S., Imrie, C.W., Neoptolemos, J.P. and Sutton, R. (2009) An open randomised comparison of clinical effectiveness of protocol-driven opioid analgesia, celiac plexus block or thoracoscopic splanchnicectomy for pain management in patients with pancreatic or other abdominal malignancies Pancreatology, 9, (6), pp. 755-763. (doi:10.1159/000199441). (PMID:20090396).

Record type: Article

Abstract

In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM). Methods: Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB, or MM+TS. Randomization was stratified by treatment centre, tumour type and previous opioid medication. The primary endpoint was pain relief at 2 months. Results: 65 patients (58 pancreas cancer) were randomized, 18 withdrew or died within 2 months. Effective pain relief was achieved in only one third of subjects at 2 weeks, and just under half at 2 months (MM: 6/19 and 5/12 evaluable patients; CPB: 5/14 and 5/9; TS 4/14 and 4/11). There were no significant differences between the groups in pain scores or opioid consumption, and there was no correlation between continued use of opioids and effective pain relief. Discussion: Previous randomized studies have shown small differences in pain scores, but no difference in opioid consumption and quality of life. The absence of any benefit from interventions in the present study questions their value.

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Published date: 2009

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Local EPrints ID: 175537
URI: http://eprints.soton.ac.uk/id/eprint/175537
ISSN: 1424-3903
PURE UUID: 93241b31-5603-44d5-9f75-1ab7b370e63c

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Date deposited: 24 Feb 2011 10:15
Last modified: 18 Jul 2017 12:09

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Contributors

Author: C.D. Johnson
Author: D.P. Berry
Author: S. Harris
Author: R.M. Pickering
Author: C. Davis
Author: S. George
Author: C.W. Imrie
Author: J.P. Neoptolemos
Author: R. Sutton

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