A 55-year-old patient with inoperable pancreatic cancer has severe upper abdominal pain (NRS 9/10) unresponsive to oral morphine 200 mg/day. Which interventional procedure targets the coeliac plexus to provide sustained pain relief?

• A Lumbar sympathetic block
• B Spinal cord stimulation at T10
• C Coeliac plexus neurolysis (CPN) with absolute alcohol ✓
• D Cordotomy at C1-C2

Explanation

The coeliac plexus carries afferent nociceptive signals from the upper abdominal viscera (pancreas, liver, stomach, small bowel). Coeliac plexus neurolysis (CPN) with absolute ethanol (50–100%) destroys these nerve fibres, providing 70–90% pain relief lasting weeks to months in pancreatic cancer pain. It reduces opioid requirements and improves quality of life. CPN can be performed under CT, endoscopic ultrasound, or fluoroscopic guidance. Lumbar sympathetic block addresses lower extremity ischaemic pain; cordotomy is reserved for refractory unilateral cancer pain; SCS is used for neuropathic pain syndromes.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.