Comparative analysis of transaortic celiac plexus rhizolysis vs. bilateral splanchnic nerve radiofrequency ablation in managing intractable pain in upper gastrointestinal malignancies: A prospective randomized controlled study

Comparative analysis of transaortic celiac plexus rhizolysis vs. bilateral splanchnic nerve radiofrequency ablation in managing intractable pain in upper gastrointestinal malignancies: A prospective randomized controlled study - Background and Aims: Intractable abdominal pain is common in patients with upper gastrointestinal malignancies and significantly impacts their quality of life. Despite pharmacological treatment, many patients do not experience sufficient pain relief. Coeliac plexus rhizolysis (CPR) and splanchnic nerve radiofrequency ablation (SRF) are two interventional techniques used to target pain pathways. CPR involves ablating the coeliac plexus, while SRF targets the splanchnic nerves. This study compares the efficacy and safety of these two procedures in managing pain in patients with upper GI cancers. Materials and Methods: Randomised, prospective, comparative and single-blinded interventional study was conducted in the Pain medicine unit, department of Anaesthesiology, in a tertiary care teaching medical institute. After ethical clearance, thirty patients were included in each group and assessed for pain by Visual Analogue Scale (VAS), the dosage of oral morphine, and quality of life (QOL) up to 6 months. Pre-procedural and post-procedural VAS scores were evaluated using the Paired Student t-test and Cohen's Method for effect analysis. An Independent student t-test was used to compare QOL and morphine consumption. Result: Both interventions resulted in significant pain relief, with splanchnic nerve radiofrequency ablation (SRF) showing greater efficacy compared to coeliac plexus rhizolysis (CPR). The pre- and post-procedure VAS scores were as follows: SRF (7.5 ± 1.04 to 2.13 ± 1.48) and CPR (7.93 ± 1.34 to 3.28 ± 1.44). The SRF group also demonstrated lower morphine consumption (13.4 ± 15.3 mg/day) compared to CPR (26.11 ± 23.5 mg/day) and improved QOL (WHO QOL score: SRF 67.75% vs. CPR 42.50%). Adverse events included more transient hypotension and diarrhea in the CPR group, while the SRF group had more transient backache. Conclusion: Splanchnic nerve radiofrequency ablation (SRF) demonstrates superior efficacy over coeliac plexus rhizolysis (CPR) in terms of pain reduction, opioid sparing, and quality of life improvement for patients with upper gastrointestinal malignancies. Keywords: Coeliac plexus rhizolysis, Radio-frequency ablation, Splanchnic nerve, Upper gastrointestinal malignancy.