Additive value of dexmedetomidine in endoscopic ultrasound-guided celiac plexus neurolysis for the treatment of liver cancer pain

Background Hepatocellular carcinoma is the most common primary liver cancer that usually develops in a background of cirrhosis. It is usually diagnosed at advanced stages and abdominal pain may be the first presentation where it represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in the relief of pain as a result of upper abdominal malignancy. Dexmedetomidine is an α2 adrenoreceptor highly selective agonist approved for procedural sedation use. Patients and methods Fifty patients who were divided into two groups with hepatocellular carcinoma-associated abdominal pain in need of opioid analgesics underwent endoscopic ultrasound-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second one. Patients give their abdominal pain a score according to the numeric rating scale-11 before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure. Results The study have included 50 patients who were divided in two groups: 32 men and 18 women with a mean age of 60.12±5.07 years for group 1 and 58.32±5.03 years for group 2. There were no significant difference between the two groups as regards medical, laboratory, or tumor characteristics. The median pain score decreases from 8.32±0.75 before the procedure to 3.75±3.72 24 week after the procedure in group 1 and from 8.08±0.86 before to 1.67±2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks of follow-up. There was no statistically significant difference between the two groups as regards the median survival time. Conclusion The addition of dexmedetomidine to bupivacaine 0.5% in endoscopic ultrasound-CPN demonstrated beneficial effects as regards the degree and duration of pain relief with negligible effect on patient survival.