Coeliac Plexus vs Splanchnic Nerve Neurolysis for Upper Abdominal Cancer Pain

NCT07653906 | Recruiting

• 1 other identifier: BMU/2026/1940
• Study Type: interventional
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial is to determine whether Neurolytic Splanchnic Nerve Block (NSNB) reduces pain in adults with upper abdominal malignancies. It will also evaluate the safety of Neurolytic Splanchnic Nerve Block (NSNB). The main questions it aims to answer are: Does NSNB reduce pain intensity compared to Neurolytic Coeliac Plexus Block (NCPB), as measured by the Visual Analog Scale (VAS)? What adverse effects do participants experience when receiving Neurolytic Splanchnic Nerve Block (NSNB)? Investigators will compare Neurolytic Splanchnic Nerve Block (NSNB) with Neurolytic Coeliac Plexus Block (NCPB) to determine which intervention provides more effective and safer pain relief. Participants will:

• receive either NSNB or NCPB under fluoroscopic guidance
• be monitored immediately and for 2 hours after the procedure for any complications Have their pain intensity recorded immediately after the procedure, and at 7 days, 1 month, and 3 months
• be evaluated for quality-of-life using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 3 (EORTC QLQ-C30) at 1 month and 3 months.
• have their opioid consumption tracked throughout the study.

Conditions

Abdominal Neoplasms; Pain Management; Neurolytic Techniques

Keywords

Upper abdominal cancer; Splanchnic nerve block; Coeliac plexus block; Analgesic efficacy

Outcome Measures

Primary Outcomes (1)

• Pain intensity reduction as measured by the Visual Analog Scale (VAS)

  This measure evaluates the effectiveness of Neurolytic Splanchnic Nerve Block (NSNB) compared to Neurolytic Coeliac Plexus Block (NCPB) in reducing pain in patients with upper abdominal malignancies. Zero indicates no pain, and 10 indicates the worst possible pain.

  Baseline, Immediately after the intervention, at 7 days, 1 month, and 3 months post-procedure

Secondary Outcomes (3)

• Opioid Consumption

  Baseline, Day 7, 1 month, and 3 months post-procedure.

• Quality of Life using scores from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30)

  Baseline, 1 month and 3 months post-procedure.

• Incidence of immediate or delayed complications, including hypotension, diarrhea, back pain, shoulder pain, pneumothorax, or neurological changes.

  Immediately post-procedure and during follow-up visits up to 3 months.

Study Arms (2)

Control group

ACTIVE COMPARATOR

Procedure: Neurolytic Coeliac Plexus Block (NCPB)

Intervention Group

EXPERIMENTAL

Procedure: Neurolytic Splanchnic Nerve Block (NSNB)

Interventions

Neurolytic Coeliac Plexus Block (NCPB) PROCEDURE

Fluoroscopy-guided neurolytic coeliac plexus block performed on adult patients with upper abdominal malignancies. Patients are positioned prone with a pillow under the abdomen. Using posteroanterior and oblique C-arm fluoroscopy, the T12-L1 vertebral bodies are identified. After local anesthetic infiltration, 3 mL of 0.25% bupivacaine is injected, followed by 20 mL of 70% alcohol for neurolysis. A 1 mL saline flush is given during needle withdrawal to prevent track formation. Patients are monitored immediately and for 2 hours post-procedure for adverse effects including hypotension, diarrhea, back pain, shoulder pain, or neurological changes.

Control group

Neurolytic Splanchnic Nerve Block (NSNB) PROCEDURE

Fluoroscopy-guided neurolytic splanchnic nerve block performed in adults with upper abdominal malignancies. Patients are positioned prone with proper support. Using posteroanterior and lateral C-arm fluoroscopy, T11-T12 vertebral bodies and the junction of the rib and vertebral body are identified. After local anesthetic infiltration, a Chiba needle is advanced to the anterior one-third of the lateral vertebral body. Contrast dye is injected to confirm placement. Neurolysis is performed using 10 mL of 70% alcohol, preceded by 2-3 mL of 0.25% bupivacaine. A 1 mL saline flush is given during needle withdrawal to prevent track formation. Patients are monitored immediately and for 2 hours post-procedure for complications including hypotension, diarrhea, back pain, shoulder pain, pneumothorax, or neurological changes.

Intervention Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patient
• Both genders
• Diagnosed case of upper abdominal malignancy (pancreatic, gastric, hepatic, or biliary origin)
• Experiencing moderate to severe pain (≥5 on a 10 point visual analog scale)
• Patients who are conscious and can communicate
• No Contraindication for nerve block (e.g., coagulopathy, anticoagulant drugs)

You may not qualify if:

• Previous coeliac plexus block, splanchnic nerve block, or major abdominal nerve ablation
• Severe spinal deformities or anatomical distortion at the coeliac plexus or splanchnic nerve site
• Local or systemic infection at or near the block site
• Known allergy to local anesthetics or neurolytic agents
• Pregnancy
• Lactating mother
• Cognitive impairment or psychiatric illness

Sponsors & Collaborators

• Bangladesh Medical University: lead

Study Sites (1)

Bangladesh Medical University

Dhaka, 1000, Bangladesh

RECRUITING

Related Publications (9)

• Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol. 2007 Feb;102(2):430-8. doi: 10.1111/j.1572-0241.2006.00967.x. Epub 2006 Nov 13.

  PMID: 17100960 BACKGROUND

• Wiechowska-Kozlowska A, Boer K, Wojcicki M, Milkiewicz P. The efficacy and safety of endoscopic ultrasound-guided celiac plexus neurolysis for treatment of pain in patients with pancreatic cancer. Gastroenterol Res Pract. 2012;2012:503098. doi: 10.1155/2012/503098. Epub 2012 Feb 7.

  PMID: 22474439 BACKGROUND

• Warner NS, Moeschler SM, Warner MA, Hoelzer BC, Eldrige JS, Bendel MA, Mauck WD, Watson JC, Gazelka HM, Lamer TJ, Kor DJ, Hooten WM. Bleeding Complications in Patients Undergoing Celiac Plexus Block. Reg Anesth Pain Med. 2016 Jul-Aug;41(4):488-93. doi: 10.1097/AAP.0000000000000409.

  PMID: 27203395 BACKGROUND

• van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007 Sep;18(9):1437-49. doi: 10.1093/annonc/mdm056. Epub 2007 Mar 12.

  PMID: 17355955 BACKGROUND

• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016 Jan-Feb;66(1):7-30. doi: 10.3322/caac.21332. Epub 2016 Jan 7.

  PMID: 26742998 BACKGROUND

• Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005 Jun;102(6):1249-60. doi: 10.1097/00000542-200506000-00027.

  PMID: 15915040 BACKGROUND

• Lu F, Li X, Song L, Ye L, Wang X, Wang R. Efficacy and Safety of Celiac Plexus Neurolysis Versus Splanchnic Nerve Neurolysis in the Management of Abdominal Cancer Pain: A Meta-analysis of 359 Patients. Pain Physician. 2024 Jan;27(1):1-10.

  PMID: 38285023 BACKGROUND

• Davies DD. Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med. 1993 May;86(5):264-6. doi: 10.1177/014107689308600507.

  PMID: 8505748 BACKGROUND

• Shwita AH, Amr YM, Okab MI. Comparative Study of the Effects of the Retrocrural Celiac Plexus Block Versus Splanchnic Nerve Block, C-arm Guided, for Upper Gastrointestinal Tract Tumors on Pain Relief and the Quality of Life at a Six-month Follow Up. Korean J Pain. 2015 Jan;28(1):22-31. doi: 10.3344/kjp.2015.28.1.22. Epub 2015 Jan 2.

  PMID: 25589943 BACKGROUND

MeSH Terms

Conditions

Abdominal Neoplasms; Agnosia

Condition Hierarchy (Ancestors)

Neoplasms by Site; Neoplasms; Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: June 12, 2026
• First Posted: June 17, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): October 30, 2026
• Study Completion (Estimated): January 31, 2027
• Last Updated: June 17, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

BA (1)