Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis

Cancer Pain Clinical Trial

Official title:

Comparing the Effects of Coeliac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis for Non-pancreatic Upper Intra-abdominal Cancer Pain: a Prospective Randomized Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05541211
• Other study ID #: UW22-536
• Status: Recruiting
• Phase: N/A
• Start date: December 1, 2022
• Est. completion date: March 31, 2025

Study information

• Verified date: November 2023
• Source: The University of Hong Kong
• Contact: Timmy CW Chan, MBBS
• Phone: 22555791
• Email: timmychancw[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: March 31, 2025
• Est. primary completion date: September 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Cancer Pain

Intervention

Other:
• 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).
• 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).

Locations

Country	Name	City	State
Hong Kong	Queen Mary Hospital	Hong Kong

Sponsors (1)

Lead Sponsor	Collaborator
The University of Hong Kong

Country where clinical trial is conducted

Hong Kong, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	pain score	Pain intensity using numerical rating scale from 0 to 10 where 0 is no pain and 10 is the worst pain.	at one week after procedure