Celiac Plexus Block

abdominal pain5The celiac plexus is a group of nerves that supply the abdominal organs. A celiac plexus block is useful for patients with chronic abdominal or pelvic pain, or those who have pain from liver, colon, or bladder cancer.

This plexus of nerves surrounds the abdominal aorta (large vessel that comes off the heart) and the celiac and superior mesenteric arteries (vessels that take blood to the abdominal area). The network of nerve fibers come from both the sympathetic and the parasympathetic systems.

The nerves that supply the organs of the abdomen arise in the celiac plexus, including the pancreas, stomach, gallbladder, spleen, intestines, kidneys, and adrenal glands.

Before the Procedure

Before the procedure, you will be informed of where and when you are to report for your celiac plexus block. You should not eat or drink after midnight the night before. You are allowed, however, to take necessary medications with small sips of water. Do not take any long-acting pain medication the day of the procedure. Be sure to go over all medications with your doctor before you are to have the celiac plexus Celiac Plexus Blocksblock.

When you arrive, you will be instructed on the procedure and sign a consent form. An intravenous (IV) catheter is placed in your arm so the nurse can give necessary IV fluids and/or medications. You will be asked to lie on your stomach for the procedure.

The Procedure

The doctor cleans the back with an antiseptic and numbs the area with a local anesthetic. Under x-ray guidance, the doctor inserts small needles through the skin to the celiac plexus, which is located at the level of the twelve thoracic vertebra (T12) and the first lumbar vertebra (L1).

The doctor will inject a long-acting anesthetic (bupivacaine) directly into the celiac plexus to block nerve activity. For neurolytic blocks, the doctor will use either phenol or absolute alcohol. This deadens and destroys the nerves so they no longer perceive pain.

After the procedure, the doctor will ask about your pain, and you will be transferred to the recovery room for monitoring. The IV is discontinued once you are stable, and you are discharged to home. The nurse will go over you possible complications of the celiac plexus block. These include infection, bleeding, pain, low blood pressure, and paralysis (rare).

Things to Consider

There are some side effects associated with the celiac plexus block. These include:

  • Orthostatic hypotension – This is a drop in blood pressure when going from a lying or sitting position to a standing position. This can occur up to five days following the celiac plexus block, and occurs in approximately 2% of patients. Once the body adjust to the medications, the side effect disappears. Treatment includes bed rest, avoiding sudden position changes, and drinking clear fluids.pain relief3

 

  • Backache – Because there is slight tissue trauma related to the injection, some patients will have a slight backache. This is relieved with prescribe pain medications and cool compresses.

 

  • Diarrhea – Because the injection affects the nerves related to the intestines, a few patients experience loose stools. Treatment for this include replacing fluids and taking an oral anti-diarrheal agent, such as loperamide.

Outcome and Effectiveness

Pain is troubling symptom for many patients suffering from cancer and chronic conditions of the abdomen and pelvis. For many patients, usual medications and treatments are not effective.

The celiac plexus block is a procedure that has demonstrated efficacy for patients with various types of visceral pain arising from malignancy and chronic disorders. According to current research studies, the efficacy achieved is approximately 85 to 90%, regardless of the technique.

Resources

Vorenkamp, KE & Dahle, NA (2011). Diagnostic celiac plexus block and outcome with neurolysis. Pain Management 15,(1), 28-32. DOI: http://dx.doi.org/10.1053/j.trap.2011.03.001