Steroid and alcohol coeliac plexus block in chronic pancreatitis

OBJECTIVETo evaluate the indications, immediate benefit, patient outcome and side effects of either alcohol or steroid coeliac plexus block in a subset of patients with persistent severe pain due to chronic pancreatitis.DesignWe retrospectively analysed 14 patients with painful chronic pancreatitis who underwent coeliac plexus block from March 1992 to September 1993. PATIENTSPatients were ill for a mean of 7 years, and were treated for a mean of 3.3 years. Prior surgery was performed in six patients, while 13 underwent prior endoscopic management, all continued to have debilitating pain, and were unresponsive to oral medication and to appropriate ductal drainage procedures. METHODSA total of 27 coeliac plexus blocks were performed using the posterior approach. Depot steroid (n = 17) or alcohol (n = 10), diluted in local anaesthetic, were injected under fluoroscopic control. RESULTSComplete resolution or significant decrease in pain was recorded after 24 h by all patients. Duration of significant pain relief ranged from 2 days to more than 7 months (mean 2 months) after steroid coeliac plexus block, and from 4 days to 14 months (mean 4 months) after alcohol coeliac plexus block. Pain relief lasting at least 1 month was obtained in 56% of steroid and in 70% of alcohol coeliac plexus blocks. In six patients, repeating the block produced longer lasting pain relief than after the first procedure. CONCLUSIONSCoeliac plexus block is a potential component of the therapeutic armamentarium, giving selected chronic pancreatitis patients with intractable pain a few months of pain-free life.