Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis

Not Applicable

Recruiting

• Conditions: Cancer Pain
• Interventions: Other: Splanchnic nerve neurolysis; Other: Coeliac plexus neurolysis

• Registration Number: NCT05541211
• Lead Sponsor: The University of Hong Kong

Brief Summary

Pain is prevalent among patients with gastrointestinal cancers. Standard procedures such as coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases. Meanwhile, splanchnic nerve neurolysis (SNN) as an alternative to CPN is more effective for cancer pain relief.

Although previous studies investigating the role of CPN/SNN mainly focus on pancreatic cancer cases, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.

Detailed Description

Pain is prevalent among patients with gastrointestinal cancers. There is abundant evidence that coeliac plexus neurolysis (CPN) is effective in reducing pain, opioid requirement and related side effects for pancreatic cancer cases while the evidence for other upper abdominal cancer pain is less robust but emerging. Meanwhile, there is an increasing interest in utilising splanchnic nerve neurolysis (SNN) as an alternative to CPN for cancer pain relief.

Although previous studies investigating the role of CPN/SNN involved heterogenous types of intra-abdominal malignancies, majority of cases were pancreatic cancer. Therefore, their efficacy on non-pancreatic abdominal cancer pain may not be accurately determined.

Study Timeline

• Study First Submitted: 2022-09-07
• Study First Submitted QC: 2022-09-12
• Study First Posted: 2022-09-15
• Study Start: 2022-12-01
• Status Verified: 2023-11
• Last Update Submitted: 2023-11-29
• Last Update Posted: 2023-12-06
• Primary Completion: 2024-09-30
• Study Completion: 2025-03-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• Age>=18
• Diagnosis of unresectable intra-abdominal cancer
• Visceral pain attributable to the cancer with NRS >= 4
• Able to understand instructions, give consent, complete questionnaires

Exclusion Criteria

• Primary pancreatic cancer or metastatic disease involving pancreas
• Gross celiac axis distortion identified on imaging
• Acute abdomen condition eg. Intraabdominal sepsis, tumor rupture
• Other non-cancer causes attributable to the pain
• Gross ascites
• Previous coeliac plexus or splanchnic nerve neurolysis
• Contraindications to neurolytic procedures eg. Bleeding tendency; local or systemic infections; allergic to local anesthetics, contrast or alcohol; intestinal obstruction; anatomical distortion along needle trajectory
• Patients believed to be inappropriate for study by investigators

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Splanchnic nerve neurolysis (SNN)	Splanchnic nerve neurolysis	Splanchnic nerve neurolysis (SNN) will be performed bilaterally. Neurolytic solution will be injected around the splanchnic nerves (a nerve located at thoracic trunk).
Coeliac plexus neurolysis (CPN)	Coeliac plexus neurolysis	Coeliac plexus neurolysis (CPN) will be performed bilaterally. Neurolytic solution will be injected around the coeliac plexus (a network of nerves located in the abdomen).

Primary Outcome Measures

Name	Time	Method
pain score	at one week after procedure	Pain intensity using numerical rating scale from 0 to 10 where 0 is no pain and 10 is the worst pain.

Trial Locations

Locations (1)

Queen Mary Hospital; 🇭🇰 Hong Kong, Hong Kong