University Surgical Unit (816), Southampton General Hospital, Southampton, UK.
Pancreatology. 2009;9(6):755-63. doi: 10.1159/000199441. Epub 2010 Jan 15.
In inoperable malignancy, pain relief with opioids is often inadequate. Nerve block procedures may improve symptom control. Our aim was to assess celiac plexus block (CPB) and thoracoscopic splanchnicectomy (TS) in patients receiving appropriate medical management (MM).
Patients with confirmed irresectable malignancy of the pancreas or upper abdominal viscera who required opioid analgesia were randomized to MM alone, MM+CPB, or MM+TS. Randomization was stratified by treatment centre, tumour type and previous opioid medication. The primary endpoint was pain relief at 2 months.
65 patients (58 pancreas cancer) were randomized, 18 withdrew or died within 2 months. Effective pain relief was achieved in only one third of subjects at 2 weeks, and just under half at 2 months (MM: 6/19 and 5/12 evaluable patients; CPB: 5/14 and 5/9; TS 4/14 and 4/11). There were no significant differences between the groups in pain scores or opioid consumption, and there was no correlation between continued use of opioids and effective pain relief.
Previous randomized studies have shown small differences in pain scores, but no difference in opioid consumption and quality of life. The absence of any benefit from interventions in the present study questions their value.
在无法手术的恶性肿瘤中，阿片类药物缓解疼痛往往效果不佳。神经阻滞手术可能会改善症状控制。我们的目的是评估腹腔神经丛阻滞（CPB）和胸腔镜内脏神经切断术（TS）在接受适当药物治疗（MM）的患者中的作用。
对需要阿片类药物镇痛的确诊为不可切除的胰腺或上腹部内脏恶性肿瘤患者进行随机分组，分别接受 MM 单独治疗、MM+CPB 治疗或 MM+TS 治疗。随机分组按治疗中心、肿瘤类型和既往阿片类药物治疗进行分层。主要终点为 2 个月时的疼痛缓解情况。
共 65 例患者（58 例为胰腺癌）接受了随机分组，18 例患者在 2 个月内退出或死亡。2 周时，只有三分之一的患者有效缓解疼痛，2 个月时只有近一半（MM：19 例中有 6 例和 12 例可评估患者；CPB：14 例中有 5 例和 9 例；TS：14 例中有 4 例和 11 例）。各组之间的疼痛评分或阿片类药物消耗量没有显著差异，且继续使用阿片类药物与有效缓解疼痛之间无相关性。
先前的随机研究显示疼痛评分有微小差异，但阿片类药物消耗量和生活质量没有差异。本研究中干预措施没有任何获益，这对其价值提出了质疑。
