Celiac Plexus Neurolysis for Pain Management in Pancreatic and Hepatobiliary Malignancies: A Case Report and Literature Review

Abstract

Background: Chronic abdominal pain in advanced malignancies, particularly pancreatic and hepatobiliary cancers, is often refractory to conventional analgesics. Celiac plexus block (CPB) and neurolysis (CPN) are established interventional techniques that provide substantial pain relief, reduce opioid consumption, and improve patient quality of life.

Case Presentation: We report a 43-year-old male with stage IV pancreatic cancer and hepatic metastases presenting with severe upper abdominal pain unresponsive to high-dose opioids. Fluoroscopy-guided bilateral celiac plexus neurolysis using ethanol was performed. Post-procedure, pain scores decreased from NRS 6 to NRS 2–3, opioid requirements reduced, and sleep quality improved. The patient was discharged in stable condition two days later.

Discussion: CPN is a safe and effective intervention for upper abdominal cancer pain. Literature supports its opioid-sparing benefits, long-term efficacy, and favorable safety profile when performed under image guidance. Early intervention may optimize outcomes and reduce opioid-related side effects.

Conclusion: CPN should be considered early in the multimodal management of refractory abdominal pain in pancreatic and hepatobiliary malignancies.