Dose-response relationship of anhydrous ethanol for celiac plexus block performed under CT guidance in treating intractable upper abdominal cancer pain / 中华麻醉学杂志

ABSTRACT

Objective:To determine the dose-response relationship of anhydrous ethanol for celiac plexus block performed under CT guidance in treating intractable upper abdominal cancer pain.Methods:One hundred patients of both sexes with intractable upper abdominal cancer pain, aged 39-89 yr, weighing 37-64 kg, of visual analog scale score≥7, scheduled for elective celiac plexus block performed under CT guidance, were divided into 5 groups ( n=20 each) by a random number table method: mixture of different doses of anhydrous ethanol plus iohaeol groups (R 1-R 5 groups). T 12-L 1 interspace was located first.The needle was inserted at the level of T 12-L 1 interspace.The points of needle entry were determined by CT.On the left side, a needle was inserted, and the tip slid off the vertebral body anterolaterally until it reached the left slide of aorta and left crus of diaphragm.On the right side, a needle was inserted and advanced until the anterior side of the vertebral body between the right crura of diaphragm.One percent lidocaine hydrochloride 2 ml containing contrast agent (30% iodohydramol injection 0.4 ml) was injected through the left and right needle.At 20 min after CT showed that the liquid injected had been met and wrapped around the abdominal aorta, the mixture of anhydrous ethanol 8 ml (R 1 group), 10 ml (R 2 group), 12 ml (R 3 group), 14 ml (R 4 group), 16 ml (R 5 group) and iodinitol (iodinitol∶anhydrous ethanol=1∶5) was injected through the left and right needle.Effective block was defined as the visual analog scale score of superior abdominal pain≤3 and decrease in systolic pressure by more than 20% compared with the preoperative level at 10 min after the abdominal plexus block with anhydrous ethanol.The ED 50, ED 95 and 95% confidence interval of celiac plexus block in treating intractable upper abdominal cancer pain were calculated by Probit analysis. Results:The ED 50 and ED 95 (95% confidence interval) of celiac plexus block in treating refractory upper abdominal cancer pain were 11.937 (10.959-12.939) ml and 19.665 (17.448-24.212) ml, respectively. Conclusion:The ED 50 and ED 95 of anhydrous ethanol for celiac plexus block performed under CT guidance in treating intractable upper abdominal cancer pain are 11.937 ml and 19.665 ml, respectively.