A prospective randomized trial of 1 versus 2 injections during EUS-guided celiac plexus block for chronic pancreatitis pain

Background: The efficacy of 1-injection versus a 2-injections method of EUS-guided celiac plexus block (EUS-CPB) in patients with chronic pancreatitis is not known. Objective: To compare the clinical effectiveness and safety of EUS-CPB by using 1 versus 2 injections in patients with chronic pancreatitis and pain. The secondary aim is to identify factors that predict responsiveness. Design: A prospective randomized study. Interventions: EUS-CPB was performed by using bupivacaine and triamcinolone injected into 1 or 2 sites at the level of the celiac trunk during a single EUS-CPB procedure. Main Outcome Measurements: Duration of pain relief, onset of pain relief, and complications. Results: Fifty-one subjects were enrolled (23 received 1 injection, 28 received 2 injections). Pain relief, which lasted a mean of 51.3 days (median 28 days, range 1-203 days) was observed in 28 subjects (55%). Thirteen of 23 subjects who received 1 injection (56.5%) had relief from pain compared with 15 of 28 subjects who received 2 injections (53.6%) (P = .8). The median times to onset in the 1-injection and 2-injections groups were 21 and 14 days, respectively (P = .99). No correlation existed between duration of pain relief and time to onset of pain relief or onset within 24 hours. Age, sex, race, prior EUS-CPB, and smoking or alcohol history did not predict duration of pain relief. Limitation: Telephone interviewers were not blinded. Conclusions: There was no difference in duration of pain relief or onset of pain relief in subjects with chronic pancreatitis and pain when the same total amount of medication was delivered in 1 or 2 injections during a single EUS-CPB procedure. Both methods were safe.