Background: Neurolytic splanchnic nerve block is used to manage pancreatic cancer pain. However, its impact on survival and quality of life remains controversial. The authors’ primary hypothesis was that pain relief would be better with a nerve block. Secondarily, they hypothesized that analgesic use, survival, and quality of life might be affected. Methods: This randomized, double-blind, parallel-armed trial was conducted in five Chinese centers. Eligible patients suffering from moderate to severe pain conditions were randomly assigned to receive splanchnic nerve block with either absolute alcohol (neurolysis) or normal saline (control). The primary outcome was pain relief measured on a visual analogue scale. Opioid consumption, survival, quality of life, and adverse effects were also documented. Analgesics were managed using a protocol common to all centers. Patients were followed up for 8 months or until death. Results: Ninety-six patients (48 for each group) were included in the analysis. Pain relief with neurolysis was greater for the first 3 months (largest at the first month; mean difference, 0.7 [95% CI, 0.3 to 1.0]; adjusted P < 0.001) compared with placebo injection. Opioid consumption with neurolysis was lower for the first 5 months (largest at the first month; mean difference, 95.8 [95% CI, 67.4 to 124.1]; adjusted P < 0.001) compared with placebo injection. There was a significant difference in survival (hazard ratio, 1.56 [95% CI, 1.03 to 2.35]; P = 0.036) between groups. A significant reduction in survival in neurolysis was found for stage IV patients (hazard ratio, 1.94 [95% CI, 1.29 to 2.93]; P = 0.001), but not for stage III patients (hazard ratio, 1.08 [95% CI, 0.59 to 1.97]; P = 0.809). No differences in quality of life were observed. Conclusions: Neurolytic splanchnic nerve block appears to be an effective option for controlling pain and reducing opioid requirements in patients with unresectable pancreatic cancer. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:

Summary: Utilizing underground geological structures for hydrogen storage is an effective approach for energy transformation. The depleted shale reservoirs can be considered as promising options for large-scale hydrogen storage because of the vast storage capacity, high containment security, and low operation cost. However, it is challenging to characterize the hydrogen transportation mechanism and estimate hydrogen storage potential in shale formations from multiscale perspectives. In this paper, we propose a multiscale model for hydrogen transport and storage in partially depleted hydraulically fractured shale reservoirs, considering the effects of gas diffusion, adsorption, slip flow, and continuous flow. By the Laplace transformation and Pedrosa substitution, a computationally effective semi-analytical solution was derived and validated with a commercial numerical simulator. A hydrogen storage capacity (HSC) assessment workflow is proposed using a typical shale reservoir in the Appalachian Basin as a case study. The results indicate that the storage capacity can reach up to 31.92×108 m3 at a high constrained injection pressure. In addition, the HSC is strongly controlled by the adsorption property, diffusion coefficient, shale composition, flow capacity between different scale media, and mobility ratio. The influence of most reservoir parameters on storage potential is negligible at low constrained pressure but critical at high constrained pressure. Such a model can be used as a robust pressure predictor and storage capacity estimator for hydrogen storage projects in partially depleted shale reservoirs.