Comparative study on anterior and posterior approaches of coeliac plexus neurolysis on chronic pancreatitis patients in a tertiary care hospital in Chennai

Introduction: Chronic unrelieved pain is not only a major drain on scarce health care resources, but it is the cause of needless suffering of millions of people worldwide. The aim of the study: Aim of the study was to compare the two approaches namely anterior and posterior for neurolysis of coeliac plexus for intractable pain in pancreatic malignancy and chronic pancreatitis. Comparison between the two approaches is ease of technique, accurate placement of needle tip at the coeliac plexus and complications. Materials and methods: Totally 40 patients with diagnosed unresectable pancreatic malignancy and chronic pancreatitis with intractable pain who attended the surgical gastroenterology department of Govt. Stanley Hospital, Chennai during the period of May 2010 to November 2010 were selected for neurolytic coeliac plexus block with 100% Alcohol. They were grouped randomly into two comprising 20 each 1. Group A: ultrasound guided neurolysis of coeliac plexus through an anterior approach. Group P: fluoroscopy guided neurolysis of coeliac plexus through a posterior approach.on the day of the procedure, the patient was kept fasting for four hours intravenous access secured with 18g venflon approach to celiac plexus was chosen randomly. During the procedure, the patients' vitals were monitored. After the procedure, the patients were kept in ICU for one day for monitoring. The next day, if stable, discharged from the hospital. They were followed by phone about the intensity of pain and any complications like diarrhoea. They were instructed to attend the SGE department at 1, 4 and 8 weeks for assessment of pain relief. Results: 34 patients with pancreatic malignancy and 6 patients of chronic pancreatitis with pain scores of 8 to 10 were taken up for the study. They were allocated randomly into 2 equal groups of 20 each. Group A underwent celiac plexus neurolysis through anterior approach with ultra-sonogram guidance. Group P underwent celiac plexus neurolysis through a posterior approach with fluoroscopic guidance. All the patients received the same amount of neurolytic agent and were followed for 8 weeks. Pain intensity was less after 1 week in group P when compared to group A. At the end of 4th and 8th week, the pain intensity in both the groups was not statically significant of p-value (0.875) assessed by Wilcox son sum test. Patient discomfort score was more in group A when compared to group P which was statically significant of p value<0.001). In our study group P (19) patients were more prone for hypotension when compared to group A (18) which was found to be less significant of p-value <0.005. In our study group P (17) patients had diarrhoea when compared to group A (13) which was found to be less significant of p-value <0.005. In our study group P (19) patients had a backache when compared to group A (2) which was found to be more significant of p-value <0.001. Conclusion: Both the groups reported a similar incidence of pain while injecting alcohol and complications like diarrhoea and hypotension, which was not significant. Patients in group P reported a significant a backache up to 2 weeks which required painkillers. So the study demonstrates both the techniques are similar in successfulness of the block, but the anterior approach is easier to perform with less discomfort to the patients.