Login to Access Video or Poster Abstract: MP74-14
Sources of Funding: none

Introduction

Chronic kidney pain can be debilitating for patients and frustrating for physicians due to a lack of consensus evaluation or treatment. Chronic narcotics are commonly used with multiple untoward effects often without satisfactory resolution of pain. The celiac plexus provides sensory innervation to multiple intraabdominal organs, including the kidneys. Alleviation of chronic renal pain can be achieved with celiac block, but this is often short-lived. Skeletonizing the renal artery, auto-transplantation and nephrectomy have all been used as last-ditch efforts for relief. We seek here to introduce a practice pattern whereby patients in whom auto-transplant or nephrectomy is considered first undergo celiac block and, if successful, then undergo definitive management.

Methods

Six patients were retrospectively identified who were considered for auto-transplant for various indications including ureteral stricture disease, chronic pain, and renal vascular disease. A single surgeon performed all procedures. Ultimately, celiac block was performed in 3 patients with chronic flank pain prior to surgery. Age, BMI, Creatinine, length of follow up, subjective pain score and use of narcotics at last visit were assessed.

Results

Of the 6 patients included in the study, 5 underwent auto-transplant. Of these 5, 2 had celiac block prior to surgery, both of which reported alleviation of pain following the block. Of note, the patient who did not undergo auto-transplant also had a successful celiac block but elected for simple nephrectomy for fear of complications with transplantation. All 3 patients who had celiac block and subsequently underwent surgery had resolution of pain and were not on narcotics at last follow-up. Of the remaining 3 patients, 2 were still taking narcotics at last follow up. Mean age was 36.8 yrs., mean BMI was 26.2 and mean follow up was 11.7 mos. All patients had normal renal function at last follow-up with mean serum Cr of 0.88 mg/dL.

Conclusions

Chronic pain syndromes are frustrating for patients, their families, and their physicians. Invasive surgical options such as auto transplant or nephrectomy are considered when conservative measures fail, but not even these methods guarantee pain relief, and can result in significant complication.. Based on our experience, we recommend celiac plexus block prior to consideration of more invasive treatment when conservative options fail.

Funding

none