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Servicios Profesionales de Anestesiología y Medicina del Dolor Centro Médico del Noroeste Tijuana BC, México V. Whizar-Lugo, F. Anzorena-Vallarino, R.

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Presentation on theme: "Servicios Profesionales de Anestesiología y Medicina del Dolor Centro Médico del Noroeste Tijuana BC, México V. Whizar-Lugo, F. Anzorena-Vallarino, R."— Presentation transcript:

1 Servicios Profesionales de Anestesiología y Medicina del Dolor Centro Médico del Noroeste Tijuana BC, México V. Whizar-Lugo, F. Anzorena-Vallarino, R. Estrada-Coronado, C. Solar-Labastida, C. Segovia-García, J. Saldaña-Huerta ONE NEEDLE TRANS-AORTIC AND RETROCRURAL NEUROLYTIC CELIAC PLEXUS BLOCK FOR SEVERE UPPER ABDOMINAL CANCER PAIN www.anestesia-dolor.org vwhizar@anestesia-dolor.org

2 One Needle,Trans-aortic and Retrocrural Celiac Plexus Neurolysis One Needle,Trans-aortic and Retrocrural Celiac Plexus Neurolysis Aim of the study To investigate the usefulness of a single needle injection for a pre-aortic and retrocrural CPN in opioid resistant cancer pain patients, who have anatomy distortion To determine the pre-crural and retro- crural neurolytic spread To determine side effects and complications of this technique

3 Anatomy and Neurolytic Agent Diffusion

4 Celiac plexus neurolysis techniques According with anatomical approaches POSTERIOR APPROACH Retrocrural, Trans-crural, and Trans-aortic ANTERIOR APPROACH Trans-gastric and Trans-hepatic

5 RETROCRURAL Standard Two needless with posterior approach PRECRURAL Posterior approach Trans-aortic Trans-crural Anterior approach Trans-hepatic Trans-gastric RETRO and PRECRURAL Posterior approach One needle technique Celiac plexus neurolysis techniques According with neddle placement

6

7 Analgesia (VAS) and % Opiod Reduction R e s u l t s PatientsType of cancerPain (VAS)% opioid reduction Follow-up NoAgeSexInitialFinalMonths 1251.8M 11 / F1Pancreas8.7±0.92.5±0.976.25%1 - 12 250.5M 1 / F1Liver8.02.097.5%3 - 7 239M 1 / F1Gastric limphoma 9.02.077.5%5 - 8 247.5M 1 / F1Stomach9.02.095.0%1 - 7 TOTAL 18 M 14 / 29.0±0.892.3±0.980.8%1 - 12

8 PatientsPain (VAS)Cancer % opioid reduction Follow-up NoAgeSexinicialfinal MonthsDead 158M101Pancreas854- 270M82Pancreas506+ 358F93Stomach907+ 435M102Gastric limphoma855- 542M82Pancreas1001- 653M83Liver953+ 762F104Pancreas02+ 837M91Stomach1001- 955M83Pancreas904- 1043M103Pancreas908+ 1151M93Pancreas1003- 1239M92Pancreas804+ 1348F81Liver1007+ 1452M83Pancreas704+ 1539M93Pancreas807+ 1643F82Gastric limphoma708- 1759M71Pancreas1005+ 1852M93Pancreas7012-

9 C o m p l i c a t i o n s Minor Local painn= 5 (-%) Transitory diarrhean= 4 (-%) Arterial hypotensionn= 2 (-%) Severe none

10 TRANS-AORTIC AND RETROCRURAL C o n c l u s i o n s 1.This technique is usefull in patients with opioid resistant/side effects upper abdominal cancer pain, who have anatomy distortion 2.It is a safe, and easy procedure 3.No neuro-vascular complications were seen 4.Satisfactory analgesia was achieved 5.Total opioid intake was reduced ONE NEEDLE CELIAC PLEXUS NEUROLYSIS


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