Authors (including presenting author) :
Chan CW (1), Lau YC (1), Ng WYS (1), Hui KM (1)
Affiliation :
(1) Department of Anaesthesia, Pain and Perioperative Medicine, Queen Mary Hospital
Introduction :
Significant proportion of cancer patients experience moderate to severe pain. Public media has reported many cancer pain patients committed suicide due to uncontrolled pain. There is increasing debate on euthanasia for terminal cancer pain patients suffering from uncontrolled pain. Neuroablation including coeliac plexus and splanchnic nerve neurolysis are effective in reducing pain and opioid requirement for upper abdominal cancer.
Objectives :
To evaluate the efficacy and safety of neuroablation for upper abdominal cancer pain at Queen Mary Hospital from 2011 to 2022.
Methodology :
Retrospective analysis was conducted on 283 patients who received neuroablation under fluoroscopy guidance performed by pain physicians for cancer pain. Pain intensity, opioid consumption and complications were analyzed.
Result & Outcome :
Of the 283 patients, 114 had primary pancreatic cancer; the remaining were largely hepatobiliary and gastrointestinal primaries, liver or intrabdominal metastases.
Significant pain reduction was achieved. 97% patients had pain relief in which more than 83% of patients had moderate to significant pain relief; 20% patients were even pain free. Nearly 65 % of patients had opioid reduction and up to 27% were successfully weaned off all opioids. This definitely would reduce opioid-related side effects e.g. drowsiness and constipation so as to improve the quality of life. The incidence of diarrhea and hypotension in our local setting were 22% and 4% respectively. These were reversible and transient side effects.
The demand for neuroablation is increasing. Less than 10 cases were performed each year from 2011 to 2015. There has been a steep increase in the number of cases since 2016. 65 cases were performed in 2021.
Conclusions: Neuroablation is safe and cost effective in treating upper abdominal cancer pain with significant reduction in pain intensity and opioid requirement. This can avoid repeated hospital admission and shorten hospital stay due to uncontrolled pain and opioid-related side effects.
More resource should be allocated to develop this service so as to meet the increasing number of cancer pain patients. Interdisciplinary and multimodal cancer pain management with collaboration of pain physicians should be encouraged.
