Clinical Journal of Pain 2000-12-01

Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer.

M Shulman, J E Harris, T R Lubenow, H A Nath, A D Ivankovich

Index: Clin. J. Pain 16(4) , 304-9, (2000)

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Abstract

To compare pain relief in metastatic pancreatic cancer patients between neurolytic celiac plexus block (NCPB) and epidural 5% butamben suspension (EBS), a material-based delivery system of a local anesthetic that produces a long-lasting differential nerve block.Open-label patient-selected parallel groups.Urban tertiary care medical center.Twenty-four adult patients with metastatic pancreatic cancer experiencing pain uncontrolled by systemic opioids who were referred to a multidisciplinary pain clinic for interventional therapy.Antecrural NCPB-block with ethanol and epidural 5% butamben suspension injections.Subjective global pain relief assessments on a 0-100% scale were made weekly for 4 weeks and then monthly. Change in opioid use postintervention.Eight patients had a single NCPB and three patients had two NCPB. Four of the former and two of the latter had successful pain relief defined to be a more than 75% reduction in pain when compared with pretreatment maintained for more than 4 weeks or until death (if less than 4 weeks). Thirteen patients received EBS in divided doses. Eleven patients received a cumulative EBS dose of 5 grams, one patient received a cumulative EBS dose of 2.5 grams, and one patient received a cumulative EBS dose of 8.75 grams. Nine of the eleven patients and each of the other two patients had successful pain relief. The overall incidence (85% EBS vs. 55% NCPB), the duration of successful pain relief, and the percent reduction in opioid use did not differ between the two groups. There were no serious complications.EBS appears to be a safe and effective alternative to NCPB in the treatment of pancreatic cancer pain.