A 62-year-old with pancreatic cancer has severe epigastric pain rated 9/10 despite oral morphine 120 mg/day equivalent. What interventional pain procedure provides the most durable relief for visceral pancreatic cancer pain?
- A Coeliac plexus neurolysis (CPL) with absolute alcohol ✓
- B Epidural steroid injection at T10–L2
- C Intrathecal opioid pump implantation
- D Lumbar sympathetic blockade
Explanation
Coeliac plexus neurolysis (CPN) using absolute alcohol (neurolytic agent) destroys the coeliac plexus ganglia that transmit visceral pain afferents from the pancreas, liver, and upper GI tract. It provides superior and durable analgesia for pancreatic cancer pain, reducing opioid consumption by 40–60% and improving quality of life. Multiple RCTs show it is superior to pharmacological analgesia alone in pancreatic cancer. CPN can be performed under CT/fluoroscopy or EUS (endoscopic ultrasound) guidance. Epidural steroids provide temporary relief for specific radicular pain. Intrathecal pumps are valid but more invasive second-line options when systemic opioids fail.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.