459: Comparison between medical management and intervention for pain in pancreas or gall bladder cancer.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic cancer related pain, Pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Pancreatic cancer is the most painful upper abdominal cancers. Nepal is the fifth most common country in the world for gall bladder cancer.[1] Local invasion by the tumor, metastasis, perineural invasion, chemotherapy induced pain are among the common causes of pain.[2] The use of drugs like NSAIDs, morphine, and adjuvants in high doses have side effects like sedation, constipation, nausea and vomiting.[3] The use of radiofrequency nerve ablation in intractable pain gives better results than oral medications.[4] We hypothesized that bilateral splanchnic nerve block reduces Numerical rating Scale (NRS) score and the daily dose of morphine.

Methods: It was a retrospective comparative study between morphine only group and B/L Splanchnic nerve block with low dose morphine. Total of 40 patients were enrolled in the study, 20 in each group. Data collection was done from 1st October 2022 to 30th September 2023. Diagnostic B/L splanchnic nerve block was given after written informed consent was obtained. Patients with NRS score of 3/10 or less underwent B/L splanchnic nerve RFNA at T10 and T11 level and NRS score was observed after 24 hrs and at 2 months post procedure.

Results: Mean age of the study population was 63.1 years. The mean NRS before block was 8 in both the groups. Our study showed the significant reduction in NRS with mean of 2.3/10 post block as compared to 8.05/10 in morphine only group in patients with pancreatic or gall bladder cancer. Reduction in the dose of morphine in the block group was also significant with average mean daily dose of 42.05mg /day as compared to 155mg per day in the morphine only group.

Conclusions: Bilateral Splanchnic Nerve Block is an effective treatment option for pain management in patients with gall bladder and pancreatic cancer. The results are better when it is done early in the course disease than when it is used as a salvage therapy. We recommend doing the procedure at the early during the treatment before upgrading the dose of opioids or increasing the dose of opioids.

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3. Coveler, A.L., et al., Pancreas Cancer-Associated Pain Management. The Oncologist, 2021. 26(6): p. e971-e982.
4. Noor, N.A., et al., Radiofrequency Ablation of the Splanchnic Nerve and Superior Hypogastric Plexus for Chronic Abdominal Pain Status Post-Abdominal Surgery. Cureus, 2020. 12(12): p. e12189.
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10. Ahmed A, Arora D. Fluoroscopy-guided neurolytic splanchnic nerve block for intractable pain from upper abdominal malignancies in patients with distorted celiac axis anatomy: an effective alternative to celiac plexus neurolysis-a retrospective study. Indian Journal of Palliative Care. 2017 Jul;23(3):274.
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13. Goyal, Sonal1; Kumar, Ajit2; Goyal, Divakar3; Attar, Pradeep2; Bhandari, Baibhav2; Purohit, Gaurav4; Mahiswar, Aditya Pal5; Gupta, Shiwam2. Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis. Indian Journal of Anaesthesia 67(12):p 1036-1050, December 2023. | DOI: 10.4103/ija.ija_439_23.
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Presenting Author: Grisuna Singh
Submitting Author: Grisuna Singh

Senior Author: Grisuna Singh

IASP 2026 Global Year theme of Neuropathic Pain: No

• Grisuna Singh: MD, FIPM - Nepal Cancer Hospital and Research center
• Abhisesh Shrestha: MD, FIPM - Patan academy of Health Sciences