Neurolisis del plexo celíaco: una revisión sistemática

Introduction: The majority of patients with cancer will develop chronic pain. The traditional treatment follows the WHO three-step ladder for cancer pain relief. However, this treatment tends to become ineffective with time. As disease progresses, higher doses of opioids are needed to accomplish an optimal control of pain, increasing adverse effects related to them and affecting quality of life. Celiac Plexus Neurolysis (CPN) is an alternative method of analgesia that can be extremely helpful for those patients. Objective: The goal of this paper is to evaluate the effectiveness of CPN in chronic pain control and review its technique. Methods: The PubMed, MEDLINE and LILACS databases were used to perform a systematic review, utilizing impact as selection criteria. The twenty-one papers we selected were organized in a table for statistical analysis. Results: The majority of studies concluded that CPN is an effective method of chronic pain control in the upper abdomen and decreases opioid consumption, although its effectiveness depends on time of administration and disease progression. Discussion: CPN is a surgical procedure that destroys the neural fibers from the celiac plexus, responsible for the sensitive innervation of the upper abdominal viscera. As a result, the afferent pathways of visceral pain are blocked, decreasing the pain. Patients that suffer from chronic pain originated in the up-per abdomen due to pancreatic cancer, chronic pancreatitis, gastric cancer, metastatic hepatic cancer, biliary cancer, esophageal cancer or other pathologies involving the upper abdominal viscera can benefit from the procedure. Multiple approaches are available; the posterior ones are associated with less damage of visceral organs and neurological complications. Image-guided approaches using computed tomography are related to better results. Complications are rare, serious complications can be found in less than 2% of patients. Conclusion: Physicians should consider CPN as a possible pain control method for patients with chronic pain originated in the upper abdominal viscera. Even though impact in mortality and pain scales may be comparable to conventional analgesic treatment, this procedure is preferable to patients due to fewer side effects and decrease in opioid consumption.