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Abstract

Intraoperative Celiac Plexus Neurolysis Combined with Frey’s Procedure for Effective Pain Relief in Patients with Chronic Calcific Pancreatitis - A Randomized Double-Blind Placebo Controlled Trial (INFARCT Trial)

Background Even with duodenum-preserving pancreatic head resection such as with the Frey procedure, the rate of recurrence of pain and analgesic drug usage is greater with small duct chronic calcific pancreatitis. The use of intraoperative neurolytic celiac plexus block in chronic calcific pancreatitis is not yet clearly defined. Objective To assess the effectiveness of neurolytic celiac plexus block while performing Frey’s procedure in a single center setting with a randomized double blind placebo controlled trial. Methods 136 chronic calcific pancreatitis patients admitted to our hospital with intractable pain were included in the study. 68 patients were allocated to Frey’s procedure with neurolytic celiac plexus block (Group I) and the remaining 68 patients were allocated to Frey’s procedure with placebo (Group II). Mean follow up period was 2.2 ± 0.5(range 1.5-3.4) years. Pain relief was the primary end-point. Results The neurolytic celiac plexus block group reported significant (P<0.0001) pain relief (98.5%) when compared with the placebo group (83.1%). Neurolytic celiac plexus block group had less opioid requirement, and better weight gain. Physical and Mental Health Composite Scales in Quality of life assessment were better in group I (P<0.0001). Multivariate regression analysis showed small duct disease significantly affects outcome (p=0.006, OR, 0.049; 95% CI, 0.006-0.421). Sub group analysis indicated that ductal diameter of 4.6-5 mm significantly affected the outcome (p=0.036). Conclusion The novel combination of Frey’s procedure with neurolytic celiac plexus block represents an effective tool in the treatment of pain in patients particularly those with small duct disease and improve quality of life in all chronic calcific pancreatitis patients.


Author(s):

Balakumaran Sathyamoorthy, Karthick Rajendran, Bennett Duraisamy, Prabhakaran Raju, Amudhan Anbalagan, Kannan Devy Gounder



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