Efficacy of Radiofrequency Splanchnic Denervation Compared to Neurolytic Retrocrural Celiac Plexus Block for Patients with Chronic Upper Abdominal Cancer Pain

Abstract

Background: Chemical neurolysis was the standard for denervation; however, radiofrequency now offers improved outcomes with lesser problems.

Design: A prospective, randomized, double-blind clinical experiment.

Methods: 52 cases were categorized into two groups: retrocrural celiac plexus neurolysis and radiofrequency splanchnic denervation. Pain score, total tramadol intake, Functional Assessment of Chronic Illness Therapy, depression and anxiety scores, and complications were assessed.

Results: The splanchnic group exhibited a reduced pain score compared to the celiac group at 2 weeks, 1, 3, and 6 months, with median (IQR) 2(2-3) versus 3(3-3), 2(2-3) versus 3(3-4), 3(2-3) versus 4(3-4), and 3(3-3) versus 4(4-4). Tramadol intake(mg) was reduced at 2 weeks,1, 3, and 6 months in the splanchnic group compared to the celiac group, with median (IQR) 150(100-150) versus 200(150-200), 150(100-150) versus 250(200-250), 150(150-200) versus 250(200-300), and 200(150-200) versus 275(250-300). Quality of life was enhanced in the splanchnic compared to the celiac group at 2 weeks, 1, 3, and 6 months, with mean ± SD values of (92.5±3.9 vs 84.7±2.9), (92.5±3.9 vs 83.9±2.6), (91.5±3.8 vs 81±1.5), and (90±3.5 vs 80±1.1). PHQ scores are diminished in the splanchnic group relative to the celiac group with median (IQR) 4.5(4-5) versus 5.5(5-6), 4(4-5) versus 5(5-6), 5 (4-5) versus 6(6-6), and 5(4-5) versus 6(6-7). Two instances of intercostal neuralgia were recorded following celiac plexus neurolysis.

Conclusion: Radiofrequency splanchnic denervation shown superiority over neurolytic retrocrural celiac plexus block in alleviating pain, reducing tramadol use, mitigating depression and anxiety, and enhancing quality of life at 2 weeks, 1, 3, and 6 months.