Intraoperative Celiac Plexus Block with Pre-peritoneal Infusion Reduces Opioid Usage in Major Hepato-pancreato-biliary Surgery: A Pilot Study.

Objective Given the role of celiac plexus block (CPB) in the management of chronic pain, we sought to investigate the utility of CPB in the control of post-operative pain in major hepato-pancreato-biliary surgeries. Summary background data CPB has been in practice for decades for the management of upper abdominal visceral pain, especially in cancer patients. Typically, in this group of patients with chronic pain, a neurolytic agent is injected to cause irreversible neural damage to achieve pain control. We aim to apply this concept to post-operative pain control by injecting bupivacaine to the celiac plexus instead of a neurolytic agent. We aim to investigate if this novel technique decreases post-operative opioid usage, offers better pain relief and leads to earlier ambulation. Methods A retrospective, single institution study comparing consecutive patients who received intraoperative CPB and pre-peritoneal infusion (PPI) with patients who received only PPI in open hepato-pancreato-biliary surgery between the year 2016 to 2019 by a single surgeon. Patients with incomplete data on PCA usage and post-operative ambulation information were excluded. Results Patients with CBP used 31% less morphine on POD1 compared to patient without CBP and 42% less morphine on POD2. Overall average morphine usage was significantly lower in patients with CBP. Duration of PCA was shorter for patient with CBP compared with patient without CBP. The dynamic visual analogue score was marginally better in patients with CBP. Time to ambulation was similar in both groups. Conclusions CPB can be considered a part of the multimodal approach for post-operative pain management in open hepato-pancreato-biliary surgeries.