A celiac plexus block may control pain in up to 75% of patients with pancreatic cancer and allow reduction of opioid doses and their side effects. The patients pain is well controlled on his current regimen, so increasing analgesics is not necessary. Opioid rotation is sometimes helpful, but the suggested starting dose of transmucosal fentanyl is 200 µg. The addition of nalbuphine is contraindicated in patients using full µ-receptor agonists. Finding a means to continue analgesia with fewer side effects is a goal of rational pain management.
- Refer patient for consideration of celiac plexus block.
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