الفهرس 
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Abstract
The primary hypothesis for our study was that injection of bupivacaine before neurolysis dilutes alcohol and decreases its induced nerve lysis decreasing its pain reducing effect and duration for pain relief. Also, we supposed that bupivacaine injection immediately before alcohol would have no influence on immediate post procedural pain or even pain experienced during recovery. So, our primary study aim was to test our hypotheses regarding the better long-term effect of EUS-CPN without Bupivacaine. Secondary aims included assessing differences in post procedural pain, narcotic use, adverse events or even survival between studied groups. This Study was a single center randomized, double blinded, parallel groups, non-inferiority clinical trial taking place at the endoscopy unit of the Centre Hospitalier de l’Université de Montréal (CHUM) in Québec, Canada. Baseline criteria for patients in both groups were similar with no statistical significance. Patients in group I had earlier onset of pain relief and GRSC improvement after 3 days from the CPN and more durable pain reducing effect than group II patients. Added to that, group I patients had greater absolute Likert score change at 120 days (2.90±1.74) than group II patients (1.20±1.23). Efficacy seems to be better for CPN with absolute alcohol only. No severe adverse events occurred along course of this study. However, group II patients had more adverse events compared to group I. CPN with absolute alcohol only is safer than CPN with absolute alcohol and Bupivacaine. On contrary to what would be expected, chemotherapy correlates negatively to pain control after CPN. Being safer and more effective, CPN without Bupivacaine may be a better alternative to CPN with Bupivacaine.