Neurolytic procedures can produce long-term blocking by destroying nerve tissue. This kind of nerve blockage lasts until the nerves regenerate. Pain is not only conducted by the afferent and sensory nerve fibers, but also the sympathetic nerve system. Most neurolysis procedures are directed toward the sympathetic nerve structures.
Today, by means of CT guidance, the neurolytic drug can be injected with high precision with a minimal risk of exposing the surrounding structures to the neurolytic chemicals. CT guidance also provides for a better possibility for optimal placement of the needle in cases where tumor masses have changed the normal anatomical conditions of the retroperitoneal room. The procedure is performed in cooperation with interventional radiologists.
Invasive techniques still play an important role in treating cancer pain in a correct selected group of patients. The quality of the blockages increases when the procedure is guided by imaging and with the help of an interventional radiologist. Neurolytic blockades should never be considered an isolated treatment form, but as part of a broader treatment strategy, where one of the goals is to reduce the need of strong opioids and other analgesic.
Celiac plexus neurolysis is the most common neurolytic blockage for patients with pain associated with cancer. It has been shown that patients with pancreatic cancer can obtain significant pain relief from a single (sympathetic nerve) blockade for the remainder of their life, on condition that distribution to sympathetic nerves are satisfactory.
Access to the celiac plexus is reached by:
- Posterior antecrural or retrocrural access. May be done with C-bow, but preferably CT.
- Endoscopic ultrasound-guided access (via gastroscopy with ultrasound.)
- Open abdominal. Neurolysis can be performed preoperatively (in connection to exploratory laparotomy.)
Pain, often deep, diffuse and localized to the upper abdomen with radiating pain to the back. This treatment is primarily for patients with pancreatic cancer, but also those with malignant tumors in the upper abdomen, suffering from visceral pain, may benefit from this blockage.
Refractory nausea for the same patient group.
Neurolysis of the celiac plexus (sympathetic nerves) may be appropriate for different cancer types in the upper abdomen, but is mostly utilized for pancreatic cancer. Visceral pain is the one that can be alleviated by this blockade. Sensory and sympathetic nerve fibers from all organs in the upper part of the abdominal cavity, including bowel up to and including proximal part of colon, goes through the celiac plexus.
Improved pain control and reduced side effects from opioid pain relievers due to dosage reduction.