Opioid-Sparing Effect of Fluoroscopy-Guided Neurolytic Coeliac Plexus Block in Advanced Upper Abdominal Malignancy: A Prospective Comparative Study in Bangladesh

Salma Azad Tanni; Kazi Mahzabin Arin; Md Mostafa Kamal; Chhamita Sultana Chhanda; AKM Akhtaruzzaman

doi:10.62848/bjpain.v6i1.6415

Authors

Salma Azad Tanni Classified Anaesthesiologist (CMH) and Advanced Clinical Fellow, Pain Medicine, Department of Anaesthesia, Analgesia and Intensive Care Medicine; Bangladesh Medical University. https://orcid.org/0009-0009-3858-3268
Kazi Mahzabin Arin Assistant Professor and Advanced Clinical Fellow, Pain Medicine, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University. https://orcid.org/0009-0004-0064-3847
Md Mostafa Kamal Assistant Professor (OSD, DGHS) and Advanced Clinical Fellow, Pain Medicine, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University. https://orcid.org/0000-0002-4665-1904
Chhamita Sultana Chhanda Assistant Professor (OSD, DGHS) and Advanced Clinical Fellow, Pain Medicine, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University. https://orcid.org/0009-0000-2274-0729
AKM Akhtaruzzaman Professor and Head, Division of Regional Anaesthesia and Pain Medicine, Department of Anaesthesia, Analgesia and Intensive Care Medicine; Bangladesh Medical University. https://orcid.org/0000-0002-2427-1863

DOI:

https://doi.org/10.62848/bjpain.v6i1.6415

Keywords:

Neurolytic coeliac plexus block; Cancer pain; Upper abdominal malignancy; Opioid-sparing; Quality of life

Abstract

Background: Pain associated with advanced upper abdominal cancer is frequently intense, chronic, and difficult to manage. Although opioids remain the cornerstone of treatment, increasing dosages can produce drowsiness, nausea, constipation, and cognitive impairment, compromising patients' functional status and quality of life. Neurolytic coeliac plexus block disrupts visceral pain transmission, which may offer long-term analgesia while lowering opioid use and treatment-related side effects. However, comparable data is sparse in resource-constrained areas like Bangladesh.

Objective: To compare fluoroscopy-guided NCPB with conventional opioid-based therapy for pain relief, opioid consumption, quality of life and adverse events in adults with advanced upper abdominal malignancy.

Methods: This prospective observational comparative study was conducted at Bangladesh Medical University from July 2025 to June 2026. Thirty consecutively enrolled adults with confirmed advanced upper abdominal malignancies and moderate-to-severe pain (VAS ≥5) were included. Based on clinical decision-making, 15 underwent fluoroscopy-guided bilateral NCPB with 50% alcohol, while 15 received conventional opioid therapy. VAS scores, opioid consumption in morphine milligram equivalents per day (MME/day), EORTC QLQ-C30 scores, and adverse events were assessed at baseline, Day 7, 1 month, and 3 months. Group differences and changes during follow-up were analysed, with p<0.05 considered statistically significant.

Results: Baseline characteristics were comparable between the groups. At 3 months, the NCPB group had significantly lower VAS scores (4.2 ± 1.5 vs 7.4 ± 1.6) and opioid consumption (38.00 ± 13.47 vs 101.67 ± 19.61 MME/day) than the conventional opioid group (both p<0.001). NCPB also produced greater improvement in EORTC QLQ-C30 functional and quality-of-life scores, with lower pain and fatigue scores (all p<0.001). Nausea/vomiting, constipation, and sedation were less frequent after NCPB, although procedure-related pain was more common.

Conclusion: Fluoroscopy-guided NCPB provided superior, sustained pain relief, marked opioid sparing and better quality of life than conventional opioid therapy, with a favourable safety profile.