Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Anesthesia and Pain Relief

Intractable pain occurs frequently in patients with advanced cancers originating from upper abdominal viscera such as pancreas, stomach, duodenum, proximal small bowel, liver and biliary tract as well as from compressing metastatic enlarged celiac lymph nodes.Non-narcotic medical therapies are often inadequate, and opioids commonly induce nausea, vomiting, constipation and other side effects. Non-pharmacological therapies are commonly administered with the aim of improving pain control and quality of life, while reducing the risk of drug-induced side effects. Such therapies include celiac plexus neurolysis (CPN).CPN refers to the ablation of the plexus (chemical splanchnicectomy which ablates the afferent nerve fibers that transmit pain from intra-abdominal viscera), and is often achieved with alcohol. (Akinci et al., 2005).Percutaneous CPN can be performed with high success and low complication rates under imaging guidance such as fluoroscopy, angiography, magnetic resonance imaging (MRI), ultrasound (US) and computed tomography (CT) in an attempt to locate the exact level of the celiac artery origin (Akinci et al., 2005)1Nazla

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