게시판
| 21KS-015 |
Celiac plexus block with botulinum toxin in severe chronic pancreatitis
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine,
The Catholic University of Korea, Seoul, Korea 1
Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea2
Introduction
The most frustrating symptom in patients with chronic pancreatitis is constant abdominal pain. The characteristics of pancreatic pain are recurrent, intense and long-lasting. The celiac plexus block (CPB) is the optimal approach to manage the intractable abdominal pain from chronic pancreatitis. And the botulinum toxin (BoNT) has been widely used for various conditions associated with pain.
So we expected that CPB with BoNT would resolve uncontrolled abdominal pain in chronic pancreatitis for the long-term effect.
Case report
A 32-year-old male patient was referred for pain control in chronic pancreatitis from the Department of General Surgery to our pain clinic.
He had a history of repeated admissions for treatment of acute pancreatitis and necrotizing pancreatitis resulting from heavy habitual consumption of alcohol since the age of 19 years. Six years ago, he was diagnosed with chronic pancreatitis, which showed on computerized tomography (CT) as a pancreatic duct stone. He had repeated endoscopic retrograde cholangiopancreatography (ERCP), drainage catheter insertion and removal, and also had a catheter on the pancreatic duct (Figure 1). The patient reported persistent epigastric and back pain with stabbing and shooting sensation. The patient\'s range of motion was limited because of the severe pain, aggravated by laying on his back and rated pain intensity as 10/10 on a numeric rating scale (NRS). The medication treatment by opioid analgesics, which converted to an average dose of intravenous morphine of approximately 55 mg/day, had minimal effect.
CPB was performed at the L1 level under fluoroscopic guidance. Contrast media was used to check correct positioning of the needle, and 1% lidocaine 3 mL, 0.25% bupivacaine 5 mL and BoNT-A (BOTOX®, Allergan) 50 IU mixed with 2 mL normal saline was injected on each side (Figure 2).
After 15 weeks, pain was decreased to 0/10 on a visual analogue scale, without opioids or tramadol. There were no adverse effects from the injection of the BoNT-A.
Conclusion
Our case demonstrates the efficacy of CPB with BoNT in intractable pain due to severe chronic pancreatitis.
References
1. Andren-Sandberg A. Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol. 2002;14(9):957-970
2. Kumar R. Therapeutic use of botulinum toxin in pain treatment. Neuronal Signaling. 2018;2(3): 1-18
The most frustrating symptom in patients with chronic pancreatitis is constant abdominal pain. The characteristics of pancreatic pain are recurrent, intense and long-lasting. The celiac plexus block (CPB) is the optimal approach to manage the intractable abdominal pain from chronic pancreatitis. And the botulinum toxin (BoNT) has been widely used for various conditions associated with pain.
So we expected that CPB with BoNT would resolve uncontrolled abdominal pain in chronic pancreatitis for the long-term effect.
Case report
A 32-year-old male patient was referred for pain control in chronic pancreatitis from the Department of General Surgery to our pain clinic.
He had a history of repeated admissions for treatment of acute pancreatitis and necrotizing pancreatitis resulting from heavy habitual consumption of alcohol since the age of 19 years. Six years ago, he was diagnosed with chronic pancreatitis, which showed on computerized tomography (CT) as a pancreatic duct stone. He had repeated endoscopic retrograde cholangiopancreatography (ERCP), drainage catheter insertion and removal, and also had a catheter on the pancreatic duct (Figure 1). The patient reported persistent epigastric and back pain with stabbing and shooting sensation. The patient\'s range of motion was limited because of the severe pain, aggravated by laying on his back and rated pain intensity as 10/10 on a numeric rating scale (NRS). The medication treatment by opioid analgesics, which converted to an average dose of intravenous morphine of approximately 55 mg/day, had minimal effect.
CPB was performed at the L1 level under fluoroscopic guidance. Contrast media was used to check correct positioning of the needle, and 1% lidocaine 3 mL, 0.25% bupivacaine 5 mL and BoNT-A (BOTOX®, Allergan) 50 IU mixed with 2 mL normal saline was injected on each side (Figure 2).
After 15 weeks, pain was decreased to 0/10 on a visual analogue scale, without opioids or tramadol. There were no adverse effects from the injection of the BoNT-A.
Conclusion
Our case demonstrates the efficacy of CPB with BoNT in intractable pain due to severe chronic pancreatitis.
References
1. Andren-Sandberg A. Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol. 2002;14(9):957-970
2. Kumar R. Therapeutic use of botulinum toxin in pain treatment. Neuronal Signaling. 2018;2(3): 1-18
.jpg)
