Supplementary Material for: An Open Randomized Comparison of Clinical Effectiveness of Protocol-Driven Opioid Analgesia, Celiac Plexus Block or Thoracoscopic Splanchnicectomy for Pain Management in Patients with Pancreatic and Other Abdominal Malignancies
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C.D. Johnson, D.P. Berry, S. Harris, R.M. Pickering, C. Davis, S. George, C.W. Imrie, J.P. Neoptolemos, R. Sutton
2017
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). <i>Methods:</i> 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. <i>Results:</i> 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. <i>Discussion:</i>
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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Date 2017-09-26
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