Opioid-Sparing Effect of Celiac Plexus Neurolysis in Palliative Care Patients with Upper Abdominal Cancer: A Single-Center Retrospective Case Series of Thirteen Patients.

Purpose: Whether celiac plexus neurolysis (CPN) retains opioid-sparing efficacy in palliative care patients receiving modern extended-release opioids remains uncertain after a recent randomized trial that reported no benefit. We describe fluoroscopy-guided CPN in such patients. Methods: Thirteen consecutive palliative care patients with unresectable or metastatic upper abdominal cancer (seven pancreatic, five hepatobiliary, one gastric) on strong opioid therapy underwent posterior fluoroscopy-guided CPN with absolute ethanol after a diagnostic lidocaine block. Daily oral morphine equivalent (OME) and Numeric Rating Scale (NRS) pain scores were recorded at baseline and 1, 2, and 4 weeks. Pain response was defined a priori as ≥30% NRS reduction. Results: Median age was 67 years, baseline median OME 86.5 mg/day (range, 15~215), and median NRS 6. Median OME decreased to 72, 60, and 57.5 mg/day at 1, 2, and 4 weeks (median reductions 46.5%, 26.7%, 43.5%; all P≤0.002), and median NRS improved to 3, 4, and 4 (all P≤0.001). A pain response was achieved in 8/13 (61.5%) at 1 week, 7/13 (53.8%) at 2 weeks, and 5/12 (41.7%) at 4 weeks. Opioid-related adverse events declined numerically (nausea, 7/13→3/12; constipation, 4→2; somnolence, 2→0; all McNemar P>0.10). No procedural complication occurred (0/13). Conclusion: CPN was followed by reduction in opioid use and pain scores, with resolution of opioid-related symptoms and no complications. Although limited by the small sample size, these findings suggest a potential role for CPN in palliative care patients receiving extended-release opioids and warrant prospective investigation.