Comparison of Ultrasonogaphy Vs Fluoroscopy Guided Coeliac Plexus Block for Relief of Pain in Chronic Pancreatitis–An Observational Study

Inroduction: This study was done to compare between Ultrasonography Vs. Fluoroscopy Guided Coeliac plexus block for relief of pain in chronic pancreatitis. The patients were undergoingtreatment at medicine/gastroenterology/surgery departments of R.G.Kar Medical College(Kolkata) for more than 6 months, not responding to conservative treatment and were referred to pain OPD for subsequent pain management.

Materials and Methods: A group of 32 patients, aged 18-60 years, categorised as ASA III (suffering from chronic pancreatitis and not responding to conservative treatment) were divided into Group U and Group F, undergoing Ultrasonography and Fluoroscopic guided coeliac plexus blocks respectively. Each group consists of 16 patients. Thorough clinical and biochemical tests were done before the procedures. The time of needle placement, reduction of visual analogue scale(VAS) scores, haemodynamic stability, side-effects, patient satisfaction and need for rescue analgesics were compared between the two groups.

Results:
• The time of needle placement was faster in ultrasonography guided procedure (p Value 0.000).
• In the long term ultrasonography (USG) guided procedure yields greater reduction in VAS score (p Value 0.006 in 12 weeks).
• The fall in Blood Pressure(BP) in 15^th minute was more in ultrasound guided technique(p value 0.000), whereas the fall in blood pressure in 30th minute was more in Fluoroscopy guided technique (p value 0.000).
• Side-effects (p value 0.500), need for rescue analgesics(p value 0.758) were comparable in both groups.
• Patient satisfaction were similar with Ultrasonography than Fluoroscopy techniques (p value 0.887).

Conclusion: Transabdominal Ultrasonography guided coeliac plexus block (transhepaticapproach) can be a safer, faster, reliable, more patient friendly alternative to Fluoroscopy guided coeliac plexus block (transaortic approach) with better results.

Keywords: Coeliac Plexus Block, Ultrasonography, Fluoroscopy, ASA, VAS Score.