A 55-year-old patient with pancreatic cancer has severe epigastric pain not controlled by oral morphine 120 mg/day. A coeliac plexus neurolytic block is planned. What is the mechanism of pain relief and the agent used for neurolysis?
- A Permanent destruction of coeliac plexus afferents using absolute alcohol (50–100%) or 6% phenol ✓
- B Reversible blockade using bupivacaine 0.5% targeting the splanchnic nerves
- C Spinal cord stimulation at T10 level to provide gate-control analgesia
- D Intrathecal morphine injection into the coeliac cistern
Explanation
Coeliac plexus neurolytic block provides long-term pain relief for upper abdominal cancer pain (pancreatic, gastric, hepatic) by permanently destroying the afferent sympathetic fibres of the coeliac plexus using neurolytic agents — absolute alcohol (50–100%) causing protein denaturation, or 6% phenol. It is distinct from a diagnostic/therapeutic coeliac plexus block (using local anaesthetic). RCTs demonstrate superior analgesia and opioid-sparing compared to opioids alone, with response rates 70–90% for pancreatic cancer. Complications include orthostatic hypotension (from splanchnic vasodilation) and diarrhoea.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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