Subcostal TAP block provides pain relief for chronic pancreatitis patients

UK: Subcostal transversus abdominis plane (TAP) block may be an option for patients with abdominal pain secondary to chronic pancreatitis, a recent study published in the journal Pain Medicine has found. The study further found that the block is ineffective in producing clinically significant pain relief in the presence of ongoing pancreatic inflammation.

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to permanent damage. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic hormones, according to The National Pancreas Foundation. It is often accompanied by chronic abdominal pain – including visceral abdominal pain syndrome (VAPS) and abdominal myofascial pain syndrome (AMPS). Subcostal transversus abdominis plane block is an abdominal plane block that has been proven effective in upper abdominal pain of somatic origin.

Gopinath Niraj and Yehia Kamel, from University Hospitals of Leicester NHS Trust, Leicester, UK, discussed the two distinct types of chronic abdominal pain as a result of pancreatitis and presented a prospective audit of a management pathway.

The study involved a prospective audit of 54 patients with chronic abdominal secondary to pancreatitis, over a period of three years. Patients were offered bilateral subcostal transversus abdominis plane block with depot steroids as the primary interventional treatment in the pathway.

Overall, 39 patients (22 with AMPS and 17 with VAPS) consented to receive subcostal TAP block, but the procedure was abandoned in one patient with AMPS.

Key findings of the study include:

• All 38 patients who successfully received subcostal TAP block reported a numb upper abdomen and significant reduction of pain within 30 minutes of the procedure.


• In patients with myofascial pain secondary to chronic pancreatitis, the block was effective in producing clinically significant pain relief at three months (95%, 20/21) and durable pain relief lasting six months (62%, 13/21).


• In patients with visceral pain, the block produced a transient benefit lasting two to three weeks in one-third (six of 17).

“Subcostal TAP block can provide clinically significant pain relief in abdominal myofascial pain syndrome secondary to viscerosomatic convergence as a result of chronic pancreatitis in the absence of clinical and diagnostic features of active inflammation,” the authors conclude.

“Subcostal TAP block may be used in the differential diagnosis of chronic abdominal pain in patients with a history of chronic pancreatitis,” they add.

More Information: "Ultrasound-Guided Subcostal TAP Block with Depot Steroids in the Management of Chronic Abdominal Pain Secondary to Chronic Pancreatitis: A Three-Year Prospective Audit in 54 Patients" published in the journal Pain Medicine.

DOI: https://doi.org/10.1093/pm/pnz236

Journal Information: Pain Medicine