Celiac Plexus Block

The Celiac Plexus Block – What is It?

A celiac plexus block is often used for chronic, severe abdominal pain, and it is particularly effective for pancreatic cancer pain and chronic pancreatitis. Blocking the celiac plexus nerves will alleviate pain associated with any one of the internal organs.

What is the Celiac Plexus?

The celiac plexus is a bundle of nerves located behind the stomach near the abdominal aorta and the celiac artery. These nerves innervate the pancreas, liver, gallbladder, spleen, stomach, intestines, kidneys, and adrenal glands.

How do I Prepare for the Procedure?

Before the procedure, you need to notify the doctor of all medications you are taking. Certain blood-thinning agents must be held for several days prior to the procedure. Notify the doctor if you are allergic to latex or any solutions used in medical procedures. When you arrive at the surgical center, a nurse will discuss the procedure risks and benefits and have you sign a consent form. After you change into a procedure gown, a nurse places an IV catheter in your arm to administer necessary medications.

What Happens during the Procedure?

The celiac plexus block usually takes around 30 minutes to perform. After a sedative or anesthesia is given, the back is cleaned with an antiseptic solution. The skin is numbed with a local anesthetic. Contrast dye is injected into the region, and x-ray guidance is used to assure correct position of the needle. Once the needle is in place, the doctor injects medication (a local anesthetic, alcohol, and/or phenol), which will destroy the nerves.

What can I expect After the Procedure?

After you have the celiac plexus block, a nurse will monitor your vital signs and pain until you are stable. A bandage is left on the needle insertion site, and you must keep the area clean and dry. You must have someone with you to drive you home, and should take it easy for a few days. Mild hypotension (low blood pressure) often occurs following the procedure, but this will resolve within a few hours. Full effects of the block are felt within a few days.

When I Get Home, What Happens?

Expect to have some soreness of the back for a few days, and you may have loose bowel movements for 2-4 days. You should avoid alcohol for 48 hours after the procedure, and do not drive or use heavy machinery for a while. Do not soak in a tub or swim for 2 weeks. We recommend resting for 2-3 days, but you may shower the day after the procedure.

Is the Celiac Plexus Block Effective?

The celiac plexus block is effective for reliving chronic lower abdominal pain that arises from the pancreas, gallbladder, liver, mesentery, omentum, and alimentary tract from the large colon. Pain from these structures is not easily treated with oral pain medicines. In a study that compared the celiac plexus block to other treatments, researchers found that it had an 80% efficacy rate. In another study, neurolysis was added to the block (use of radiofrequency energy to destroy the nerves). All patients reported pain relief after the block, and 75% had pain relief that was immediate and lasted for 3 months.

Resources

Erdine S (2005). Celiac ganglion block. Agri, 17(1):14-22 PMID: 15791495

Gunaratnam NT, Sarma AV, Norton ID, Wiersema MJ (2007). A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc, 54:316–324

Mercadante S & Nicosia F (1998). Celiac plexus block: a reappraisal. Reg Anesth Pain Med, (1):37-48

Ramirez-Luna MA, Chavez-Tapia NC, Franco-Guzman AM, Garcia-Saenz-de Sicilia M, Tellez-Avila F. (2008). Endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer.Rev Gastroenterol, 73:63–67.

Rykowski JJ & Hilgier M (2000). Efficacy of Neurolytic Celiac Plexus Block in Varying Locations of Pancreatic Cancer: Influence on Pain Relief. Anesthesiology, 92, 347.

Yan BM & Myers RP (2007). Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol, 102(2):430-8. PMID: 1710096.