Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. @ccf.org
Clin Gastroenterol Hepatol. 2012 Feb;10(2):186-91, 191.e1. doi: 10.1016/j.cgh.2011.09.006. Epub 2011 Sep 22.
BACKGROUND & AIMS: The efficacy of endoscopic ultrasound-guided celiac plexus blockade (EUS-CPB) for painful chronic pancreatitis (CP) is uncertain. Triamcinolone is often mixed with bupivacaine to lengthen the analgesic effect. We investigated whether addition of triamcinolone increases and lengthens pain relief compared with EUS-CPB with only bupivacaine.
We performed a single-center, blinded, randomized, controlled trial of 40 adult patients referred for EUS-CPB for treatment of painful CP. Patients were assigned randomly to groups that received EUS-CPB with triamcinolone and bupivacaine or EUS-CPB with only bupivacaine (control). Questionnaires were collected when the study began (baseline) and 1 month later. The primary end point was a decrease in the pain disability index of 10 or more points at 1 month after the procedure. Secondary end points included change in visual analogue scale, narcotic requirements, and quality of life at 1 month.
There were no significant differences in primary outcomes between groups (14.3% for patients who received triamcinolone vs 15.8% for controls; P = .64). The trial was stopped for futility. There was no significant difference between groups in immediate response rates (85.7% for patients who received triamcinolone vs 68.4% for control; P = .10), or other secondary end points, including change in pain visual analogue scale (0.4 vs 1.0; P = .83), treatment with morphine equivalents at 1 month (-7.8 vs 0.0; P = .35), change in quality of life at 1 month (SF-12 mental component: 1.3 vs -2.1; P = .44; and physical component: -0.2 vs 1.7; P = .54), or adverse events. The duration of response was shorter in the triamcinolone group (mean, 5.3 vs 0.6 mo; P = .01).
Triamcinolone does not increase pain relief or lengthen the effects of EUS-CPB.
内镜超声引导腹腔神经丛阻滞（EUS-CPB）治疗慢性胰腺炎疼痛的疗效尚不确定。曲安奈德常与布比卡因混合使用以延长镇痛效果。我们研究了与仅用布比卡因的 EUS-CPB 相比，加入曲安奈德是否会增加并延长疼痛缓解。
我们对 40 名因治疗疼痛性慢性胰腺炎而接受 EUS-CPB 的成年患者进行了一项单中心、盲法、随机、对照试验。患者随机分为接受曲安奈德和布比卡因的 EUS-CPB 组或仅接受布比卡因的 EUS-CPB 组（对照组）。在研究开始（基线）和 1 个月后收集问卷。主要终点是术后 1 个月疼痛残疾指数下降 10 分或更多。次要终点包括术后 1 个月视觉模拟评分、阿片类药物需求和生活质量的变化。
两组间主要结局无显著差异（接受曲安奈德的患者为 14.3%，对照组为 15.8%；P =.64）。该试验因无效而停止。即刻反应率两组间无显著差异（接受曲安奈德的患者为 85.7%，对照组为 68.4%；P =.10），其他次要终点也无显著差异，包括疼痛视觉模拟评分的变化（0.4 分 vs 1.0 分；P =.83），术后 1 个月吗啡等效物的使用（-7.8 分 vs 0.0 分；P =.35），术后 1 个月生活质量的变化（SF-12 心理成分：1.3 分 vs -2.1 分；P =.44；和身体成分：-0.2 分 vs 1.7 分；P =.54），或不良事件。曲安奈德组的反应持续时间更短（平均 5.3 个月 vs 0.6 个月；P =.01）。
曲安奈德不能增加 EUS-CPB 的疼痛缓解或延长其效果。
