ORIGINAL RESEARCH Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain Ahmed Abdel Ghafar Saleh 1,2 & Ahmed Sultan 1 & Mohamed A. Hammouda 1 & Ahmed Shawki 1 & Mohamed Abd El Ghaffar 3 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Background Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use. Patients and Methods Fifty patients divided in two groups with locally advanced pancreatic cancer-associated abdominal pain underwent endoscopic ultrasound (EUS)-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second. Patients scored their pain according to the Numeric Rating Scale (NRS-11) before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure. Results The study has included 50 patient in two groups. There was no significant difference between the two groups as regards medical, laboratory, or tumor characters. The median pain score decreases from 8.32 ± 0.75 before the procedure to 3.75 ± 3.72 24 week after the procedure in group 1 and from 8.08 ± 0.86 before to 1.67 ± 2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks. There was no statistically significant difference between the two groups as regards the median survival time. Conclusion The addition of dexmedetomidine to bupivacaine 0.5% in EUS-CPN demonstrated beneficial effects as regards the degree and duration of pain relieve with negligible effect on the patient survival. Keywords Pancreatic cancer . Dexmedetomidine . Celiac plexus neurolysis Background Among all solid tumors, pancreatic cancer has a very bad prognosis where the 5-year overall survival remains dismal, with only about 5–10% of patients surviving with 1-year sur- vival less than 50% [1]. Abdominal and back pain is present in up to 80% of pancreatic cancer patients, with 50–70% suffer- ing from severe pain [2]. Initially, the pain is visceral, but with the progression of the disease, somatic pain may occur. This may especially be due to the peripancreatic invasion of muscles or neural structures [3]. Palliation of pancreatic cancer-associated pain begins medically with non-opioid drugs, such as paracetamol, stepping up to opioids, such as tramadol, and, eventually, more potent opioids, such as fentanyl or morphine. However, the side effects, such as addiction, nausea, somno- lence, constipation, respiratory depression, or confusion dos- age of opioid medication sometimes limit its use, and failure to achieve adequate analgesia [4]. The celiac “plexus” is the largest plexus of the sympathetic nervous system that give nerve supply to organs in the upper abdomen (the liver, kidneys, pancreas, spleen, diaphragm, ad- renal glands, stomach, abdominal aorta, small bowel, ascend- ing colon, the proximal portion of the transverse colon, and * Ahmed Abdel Ghafar Saleh drahmedsaleh1981@gmail.com 1 Department of Internal Medicine, Hepatology & Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt 2 Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt 3 Department of Surgical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt Journal of Gastrointestinal Cancer https://doi.org/10.1007/s12029-020-00449-1