A 60-year-old man with pancreatic cancer has intractable abdominal pain despite oral morphine 120 mg/day. The MOST appropriate interventional procedure for visceral cancer pain from upper abdominal malignancy is:
- A Lumbar epidural steroid injection
- B Intercostal nerve block at multiple levels
- C Coeliac plexus neurolysis with absolute alcohol ✓
- D Intrathecal baclofen pump implantation
Explanation
Coeliac plexus neurolysis (CPN) with 50% absolute alcohol is the procedure of choice for visceral pain from upper abdominal malignancies (pancreatic, gastric, hepatic). The coeliac plexus (located anterolateral to the aorta at T12-L1) transmits afferent nociceptive signals from foregut structures. Neurolysis interrupts this pathway. CPN has been shown in RCTs and meta-analyses to reduce opioid requirements and improve pain control in pancreatic cancer. The procedure can be performed percutaneously (CT/fluoroscopy-guided), endoscopically (EUS-guided), or surgically. Lumbar epidural injections address somatic lumbar pain, not visceral upper abdominal pain.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.