How and when to use sympathetic neurolysis, including neurolytic blocks of the splanchnic nerves and celiac ganglia, to provide pain relief for patients with adenocarcinoma of the pancreas remains a topic of ongoing debate. The literature consistently shows that sympathetic neurolysis offers effective, clinically meaningful pain relief to patients with moderate to severe pain associated with advanced pancreatic cancer and that this treatment reduces the dose of opioid analgesics needed to effectively control pain for some period. However, many questions remain: Does treatment impact quality of life? What is the best technique? When should the block be performed? Is survival affected?

In this issue of Anesthesiology, Dong et al. examine pain relief, survival, and quality of life in patients with unresectable pancreatic cancer after neurolytic splanchnic nerve block in a rigorously conducted, randomized, sham-controlled, multicenter trial....

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