Celiac plexus neurolysis for intractable upper abdominal malignant pain: A review article

Celiac plexus neurolysis (CPN) is an effective intervention of upper abdominal malignant pain. Multiple approaches have been described for performing CPN. This narrative review has been done to evaluate current literature on CPN by different approaches and to determine whether anyone approaches is better. The literature search of PubMed and Google Scholar was done and relevant literature was compiled for the review. The literature was reviewed to find the preferred technique of CPN by different investigators and differences in the outcome and/or complications and side effects. Multiple techniques of CPN such as classic retrocrural approach, antecrural approach, transaortic approach, anterior approach, and transdiscal approach have been used by different researchers. Effective pain relief and improved quality of life (QOL) have been reported to be achieved by all the approaches. Unilateral transaortic approach has been found to be associated with less morbidity owing to single needle and with a lesser volume of neurolytic agent used. The most common imaging method used by a large number of researchers is c-arm fluoroscope, though few authors have recommended computed tomography scan-guided CPN, especially in cases with distorted anatomy due to disease spread or metastasis. This review has focused only on CPN by the pain physicians. Other techniques such as endoscopic ultrasound technique by gastroenterologists and splanchnic radio-frequency ablation have not been compared. CPN is an effective technique for pain control and improved QOL in upper abdominal malignant pain. The selection of approach is largely dependent on the pain physician's choice and does not show the difference in the outcomes.