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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coeliac plexus neurolesion techniques for pain due to upper abdominal cancer (pancreas cancer above all), have changed during the years. In this paper we report the results of coeliac plexus alcohol neurolysis for cancer of pancreas and of other abdominal organs achieved with the different techniques. It appears that precrural techniques provide very favorable results but they require the use of CT scan. Retrocrural techniques, while giving good results, can be performed under fluoroscopic control.
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PMID:[Techniques of celiac plexus block and clinical results]. 210 Mar 22

In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to receive either general anesthesia with fentanyl intravenously and postoperative analgesia with parenteral morphine (GA group) or general anesthesia combined with epidural bupivacaine and epidural morphine for postoperative pain relief (EP group). Analgesia was tested on a visual pain scale. Pulmonary complications were evaluated by clinical complications, blood gas analysis, x-ray film changes, and pulmonary volumes (vital capacity, forced expiratory volume in 1 second). Measurements were performed on the day before the operation and on the first 5 postoperative days. In the EP group the pain relief was significantly better on the first day (p less than 0.03). Whatever the criteria used, the rates of pulmonary complications were similar in the two groups: clinical complications 21% versus 26%, radiologic complications 50% versus 64% for GA and EP groups, respectively. Postoperative PaO2 and spirometric values were similar in the two groups. Postoperative epidural analgesia may improve the patient's comfort but does not decrease the incidence of pulmonary complications.
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PMID:Postoperative pulmonary complications: general anesthesia with postoperative parenteral morphine compared with epidural analgesia. 338 80

Benign liver tumors are relatively uncommon and, even when large enough to be symptomatic, they usually remain undiagnosed prior to exploratory laparotomy. Hemangiomas constitute the majority of benign hepatic neoplasms and are 9 times as frequent in females as in males. Most are asymptomatic but abdominal swelling, a mass, or symptoms due to compression of adjacent organs may occur and abdominal hemorrhage is reported in 4.5% of patients. Hepatic hemangioma may produce a large arteriovenous communication serious enough to cause heart failure. Recently an increased frequency of liver tumors, mostly adenomas, has been noted in women taking oral contraceptives (OCs); the cause has been attributed to estrogens. The exact incidence is unknown but believed to be low. It is most common in women in their late 20s who have been on OCs for 7 years or more. The tumor occasionally completely regresses on withdrawal of the OCs. The tumor may be discovered incidentally at laparotomy or may manifest inself by pain, a palpable mass, or catastrophic hemoperitoneum. Hepatic adenoma is usually a solitary lesion and infrequently degenerates into malignancy. Differential diagnosis includes chronic gall bladder disease and peptic ulcer. Focal nodular hyperplasia (FNH) is apparently much less frequently related to OC use and is less likely to bleed seriously than adenoma. Hepatic chemistry is usually normal in adenoma and FNH, but slight increases in serum bilirubin, serum alkaline phosphatase, and serum transaminase may occur. Primary liver cancer (hepatocellular carcinoma or hepatoma) is mostly a disease of males and in the US and Western Europe seldom develops before age 40. Fibrolamellar carcinoma, which characteristically develops in adolescents and young adults, occurs with equal sex incidence. Doubt has been expressed about its relationship to OCs. In the US about 75% of primary hepatocellular carcinomas are associated with cirrhosis, and about 5% of cirrhosis cases develop primary liver cancer. Clinical manifestations of hepatoma have been divided into 5 groups: frank cancer (62.7%), acute abdominal cancer (8%), febrile cancer (8%), occult cancer (16%), and metastatic cancer (5%). Detection of large amounts of alpha fetoprotein has proven useful in diagnosis of hepatocellular carcinoma, but values may be negative in OC users. It has been estimated that 1/3 to 1/2 of all malignant tumors eventually metastasize to the liver.
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PMID:Hepatic neoplasia: selected clinical aspects. 619 95

The celiac plexus block has been "rediscovered" by the modern multidisciplinary pain clinic. Local anesthetic blocks aid in diagnosing unusual syndromes of abdominal pain. Neurolytic blocks are important in the management of intractable pain from abdominal cancer. Therapeutic use of celiac plexus block in managing the pain of chronic pancreatitis has been expanded by the use of intraplexus steroids. This treatment carries less morbidity than surgical interventions and affords long-term pain relief.
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PMID:Celiac plexus block: diagnostic and therapeutic applications in abdominal pain. 743 43

Upper abdominal pain secondary to cancer may cause great disability to patients. Surgical sympathetic-splanchnicectomy, or coeliac plexus block, has been used to relieve intractable upper abdominal cancer pain from stomach, liver, gallbladder or pancreas for a long time. There are, however, intrinsic disadvantages when performing these procedures. Due to our long experience of therapeutic thoracoscopy, we recently performed bilateral thoracoscopic sympathetic-splanchnicectomy on 14 patients (eight male and six female) for relief of pain from primary or metastatic upper abdominal cancers. Most of them were satisfied with the immediate pain relief after the operation. In this new era of therapeutic endoscopy, endoscopic surgery will gradually take the place of open methods in treatment of many diseases. It can be anticipated that thoracoscopic lower sympathetic-splanchnicectomy is undoubtedly a good alternative method for management of intractable upper abdominal pain.
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PMID:Bilateral thoracoscopic lower sympathetic-splanchnicectomy for upper abdominal cancer pain. 752 87

Celiac plexus neurolysis is considered an effective technique for relieving abdominal cancer pain. CT yields accurate anatomical detailing, thus allowing the indirect location of the celiac plexus and the planning of needle trajectory and positioning. September 1992 to December 1993, twenty-eight celiac plexus neurolyses for pain relief were performed in 26 patients (13 men and 13 women), 17 through the anterior and 11 through the posterior access. These patients had been referred to our department for pain management. Forty-eight hours after alcoholization, 20 patients (71%) had complete pain regression and their analgesic treatment was thus discontinued. 36% of the patients did not need any analgesics for 30 to 169 days. No neurologic complications were observed. Only transient orthostatic hypotension requiring no treatment developed in all our patients during the first 24 hours after the block. To conclude, we believe celiac plexus alcoholization under CT guidance to be a safe and effective technique for relieving abdominal pain due to cancer or benign conditions. We prefer the anterior approach because it is better accepted by the patients and more easily performed by the operators.
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PMID:[CT-guided celiac ganglion block. The authors' own experience]. 782 79

Different types of pain are present in far advanced intra-abdominal cancer, sometimes in the same site too. An accurate semeiological analysis of pain is important because different types of pain often differently respond to the available therapeutical tools. In this paper the results and the complications of the most important methods of pain management in far advanced intra-abdominal cancer are examined. Analysis of the data reveals that the association of more methods, pharmacological and non, should be a rule rather than the exception.
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PMID:[Treatment of pain in advanced-stage intra-abdominal neoplasms]. 792 2

In summary, we present a case in which long-lasting relief of upper abdominal cancer pain was achieved by injections of local anesthetic through the interpleural approach. This technique may be a good alternative to coeliac plexus block in selected cases. Furthermore, if pain relief in such a case proves to be only transient, injections of dilute phenol might provide permanent relief.
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PMID:Interpleural catheter analgesia for chronic pain treatment--a case report. 793 35

Celiac plexus neurolysis is a useful analgesic technique in patients with upper abdominal cancer. Although complications are infrequent, occasionally celiac neurolysis results in paraplegia. It is hypothesized that paraplegia after celiac neurolysis results from neurolytic drug-induced spasm of lumbar segmental arteries that perfuse the spinal cord, although no data are available to support or refute the idea. Whether drugs used for celiac plexus neurolysis alter the reactivity of dogs' lumbar segmental arteries was studied in vitro. Rings of lumbar segmental arteries, suspended in Krebs-Ringer solution in organ baths, were passively stretched to the optimal point on their length-tension curve. After a 45-min rest the responsiveness of each ring was established by adding an ED50 concentration of norepinephrine to the bath. Subsequently, Krebs-Ringer solution containing a single concentration of phenol or ethanol was added. Concentrations studied included 1%, 3%, 6%, 7%, 8%, 9%, and 12% phenol; and 3%, 6%, 10%, 25%, 50%, 75%, and 90% ethanol. The magnitude of the phenol-induced contractile response was directly related to concentration, with 8%, 9% and 12% phenol, producing sustained contractile responses compared to norepinephrine-induced control contractile responses. The ethanol-induced contractile response was inversely related to concentration. Ethanol (3% and 6%) produced sustained contractile responses compared to norepinephrine-induced control contractile responses. Studies were then done to further elucidate the agonist properties of phenol and ethanol. The contractions caused by ethanol or phenol did not appear to be mediated through adrenergic, opioid, muscarinic, or serotonin receptors or sodium channels.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain 1994 Feb
PMID:Altered reactivity of isolated segmental lumbar arteries of dogs following exposure to ethanol and phenol. 778 11

Over a 3-year period, neurolytic abdominal visceral sympathectomy was performed bilaterally with 15 ml of alcohol solution (14 ml of alcohol and 1 ml of contrast material) through each needle under CT guidance to relieve upper abdominal or back pain in 27 cancer patients. Using the CT monitor, our intention was to achieve splanchnic nerve neurolysis rather than celiac plexus neurolysis. After determining the trajectory for needle placement on the CT image at the L1 level, the needles were inserted bilaterally with a simple guide apparatus. The needle tips were successfully positioned in the retrocrural space in 48 (83%) of 54 insertions. Pain was substantially relieved in 20 of 21 patients receiving bilateral splanchnic nerve neurolysis. Tissue pressure was significantly higher after alcohol injection when the needle tips were located in the retrocrural space than when they were placed in the anterocrural space. CT images after alcohol injection revealed antero- and posterocrural spread in 11 of 21 patients who received bilateral splanchnic nerve neurolysis. It was speculated that the alcohol spread through the aortic hiatus or gaps of the diaphragmatic crura. No neurologic complications were encountered. It is concluded that CT guided alcohol splanchnic nerve neurolysis is an effective treatment for upper abdominal cancer pain, and that 15 ml of alcohol solution through each needle is enough for splanchnic nerve neurolysis.
Pain 1993 Dec
PMID:CT-guided neurolytic splanchnic nerve block with alcohol. 809 May 22


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