الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pain and the treatment of pain, is an enormous medical/social issue.
Pain occurs frequently in patients with advanced cancers, especially from tumors originating from upper abdominal viscera such as pancreas, stomach, duodenum, proximal small bowel, liver and biliary tract and from compressing enlarged lymph nodes.
Treatment of intractable abdominal pain due to inoperable abdominal malignancy is important. Ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions as a treatment.
This study was carried out on 26 patients presenting with intractable cancer-related abdominal pain. Demographic characteristics show that 76% of patients were males and 24% were females. Regarding their age, 92% were >45 years and 8% were ≤45 years.
Percutaneous celiac neurolysis can be performed with high success and low complication rates under imaging guidance to obtain pain relief in such patients. Celiac plexus nerolysis may also be effectively performed for pain relief in patients with chronic pancreatitis although with less effectiveness.
Although initially celiac plexus neurolysis was performed without imaging guidance, computed tomography (CT) now is most frequently used to locate the exact level of the celiac artery origin. Ultrasound, fluoroscopy and angiography may also be used.
Both anterior and posterior approaches under CT guidance may be employed, depending on the operator’s preferences and according to the safest needle pathway. The major advantage of the anterior approach is the reduced risk of neurologic complications because the tip of the needle is anterior to the spinal arteries and spinal canal. It also avoids puncture of the aorta and permits the patients to remain supine during the whole procedure.
Celiac ganglia are located anterior to the crura of the diaphragm, over the anterolateral wall of the aorta bilaterally, and just caudal to the level of the origin of the celiac artery.
20 to 40ml of ethanol in concentrations of 95–100% is the most used
neurolytic agent in clinical practice. Ethanol or phenol as nerve destructive agents and bupivacaine or lidocaine as local anesthetics has been used for celiac neurolysis in cancer patients.
The degree of pain relief had been evaluated by using subjective and objective criteria. All patients had been interviewed before the procedure to obtain a baseline pain score for subjective criteria. Visual analogue scale (range: 0–10) with “0” corresponding no pain and “10” corresponding the worst pain was used.
Follow up of our patients had been continued for a 12 month interval, and near total pain relieve was noted in almost our patients (24 of 26).
Minor treatable complications are noted as low back pain (12 of 26 patients), hypotension (4 of 26) and transient diarrhea (4 of 26).