| Objective:The incidence of pancreatic cancer-related pain is as high as 50-90%,and it is difficult to achieve satisfactory analgesic effect with traditional drug therapy alone.Although celiac plexus block(CPB)is considered to be an effective analgesic method,clinical studies have reported conflicting analgesic effects of CPB combined with other drugs in the treatment of pancreatic cancer-related pain.Method : A randomized controlled trial of CPB combined with a single drug in the treatment of pancreatic cancer related pain was collected by computer retrieval of databases such as Pubmed Medline Embase Cochrane Library,and comparison of visual simulation(VAS)pain scores between the two groups,as well as quality of life(QOL)and survival time for adverse reactions to opioid consumption.Results:Nine RCTS involving 548 patients(CPB group,n=288;control group,n=260)with unresectable pancreatic cancer associated pain constituted our meta-analysis.All the nerve blocks studied were of high quality.Combined analysis results show that:Compared with baseline,VAS scores after treatment were significantly reduced in the CPB group at Week 2(WMD=-3.08,95% CI:-5.57 to-0.58),Week 4(WMD=-3.67,95% CI:-5.88 to-1.45),Week 8(WMD=-3.23,95% CI:-4.97,to-1.49),and Week 12(WMD=-3.19,95%CI:-4.11 to-2.27),as well as in the control group at Week 2(WMD=-2.78,95% CI:-4.58 to-0.98),Week 4(WMD=-2.12,95%:CI-4.80 to-1.36),Week 8(WMD=-2.72,95%:CI-4.32 to-1.12),Week 12(WMD=-1.50,95% CI:-2.74 to-0.26).VAS scores of 5 studies were significantly lower than those of the control group at Week 4 of treatment(WMD=-0.47,95%CI:-0.75 to-0.18),7 studies at Week 8 of treatment(WMD=-0.51,95%CI:-0.86 to-0.17),and 6 studies at Week 12 of treatment(WMD=-1.26,95%CI:-2.21 to-0.31).At Week 4 of treatment in 6 studies(WMD=-38.57,95%CI:-66.44 to-10.70),Week 8 of treatment in 6 studies(WMD=-40.41,95%CI:-58.73 to-22.08),and Week 12 of treatment in 6 studies(WMD=-39.85,95%CI:-65.10 to-14.61),the consumption of opioid in the CPB group was significantly lower than that in the control group.CPB combination drugs significantly reduced the incidence of constipation(RR=0.69,95%CI:0.26 to 0.84)and significantly increased the incidence of temporary hypotension(RR=6.84,95%CI:2.21 to 21.19)compared withtraditional drug therapy.The incidence of nausea and vomiting was similar to the control group(RR=0.99,95%CI:0.21 to 4.66),and the incidence of diarrhea was similar to the control group(RR=5.16,95%CI:0.57 to 16.89),the incidence of experimental intoxication symptoms similar to those of control group(RR = 3.82,95% CI: 0.93 to15.76),the incidence of postoperative pain of patients and the controls are similar(RR =3.66,95% CI: 0.63 to 21.39)4 study provides the quality of life,of which three study quality of life has not changed,only a study to improve the quality of life,but the control group did not change significantly the quality of life before and after the treatment 3study merger analysis showed that similar survival of experimental group and control group(HR = 0.97,95%CI: 0.84 to 1.11).Conclusion:The addition of CPB in traditional drug therapy can significantly improve the analgesic effect of patients with pancreatic cancer related pain,reduce the use of opioids and constipation,but it is difficult to improve QOL and survival.CPB combined drugs can be used as a salvage analgesic scheme for patients with traditional drug therapy failure and/or adverse reactions intolerance. |
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