Central vs. Bilateral Endoscopic Ultrasound-Guided Celiac Plexus Block or Neurolysis: A Comparative Study of Short-Term Effectiveness
Central vs. Bilateral Endoscopic Ultrasound-Guided Celiac Plexus Block or Neurolysis: A Comparative Study of Short-Term Effectiveness
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DOI：
10.1038/ajg.2008.64
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发表时间：
2009-02-01
影响因子：
9.8
通讯作者：
Paquin, Sarto C.
中科院分区：
文献类型：
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作者：
Sahai, Anand V.;Lemelin, Valery;Paquin, Sarto C.
目的：内窥镜超声(EUS)引导下的腹腔神经丛阻滞/松解术(CPB/N)可通过在腹腔轴的底部(中央)或两侧(两侧)注射来完成。中央CPB/N更容易，也可能更安全。双侧CPB/N难度较大，但当到达更多神经节时可能会更有效。本研究的目的是比较中心CPB/N和双侧CPB/N的短期安全性和有效性。方法：连续转诊到第四纪EUS中心的CPB/N患者均符合本研究条件。在研究的前半部分使用中央CPB/N，在后半部分使用双边CPB/N。主要结果是第7天视觉模拟疼痛评分下降的百分比。结果：共有184名患者符合条件。其中，24人(13%)因数据不完整而被排除在外。共留下160个(中央71个，双侧89个)。在所有有说服力的变量上，这些组都是相似的。双侧CPB/N组较中心CPB/N组疼痛减轻70.4%(61.0~80.0%)和45.9%(32.7~57.4%)，P=0.0016。预测疼痛减轻50%的唯一指标是双侧CPB/N(优势比3.55，1.72-7.34)。仅有一例并发症发生：双侧腹膜丛(CP)阻断术后因肾上腺动脉撕裂致自限性出血。结论：(I)双侧CPB/N比中心CPB/N更有效；(Ii)双侧CPB/N是安全的，但极少数情况下会损伤左肾上腺动脉，因此对有出血条件的患者应避免。
OBJECTIVES: Endoscopic ultrasound (EUS)-guided celiac plexus block/neurolysis (CPB/N) can be performed by injecting at the base (central) or on either side (bilateral) of the celiac axis. Central CPB/N is easier and possibly safer. Bilateral CPB/N is more difficult but may be more effective as it reaches more ganglia. The aim of this study was to compare the short-term safety and efficacy of central and bilateral CPB/N.METHODS: Consecutive patients referred for CPB/N to a quaternary EUS center were eligible for this study. Central CPB/N was used in the first half of the study period and bilateral CPB/N in the last half. The primary outcome was the percent reduction in visual analog pain scores at day 7.RESULTS: A total of 184 patients were eligible. Of these, 24 (13%) were excluded for incomplete data. A total of 160 were left (71 central, 89 bilateral). The groups were similar for all cogent variables. Bilateral CPB/N was more effective than central CPB/N (mean percent pain reduction 70.4% (61.0-80.0) vs. 45.9% (32.7-57.4); P = 0.0016). The only predictor of a > 50% pain reduction was bilateral CPB/N (odds ratio 3.55, 1.72-7.34). Only one complication was noted: self-limited bleeding because of laceration of the adrenal artery following bilateral celiac plexus (CP) block in an anticoagulated patient.CONCLUSIONS: (i) Bilateral CPB/N is more effective than central CPB/N; (ii) bilateral CPB/N is safe, but on rare occasions can cause trauma to the left adrenal artery; it should therefore be avoided in patients with a bleeding diathesis.