What is a Celiac Plexus Block?

Celiac plexus blocks explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Celiac Plexus PositionCeliac plexus blocks are an effective treatment method that is often recommended for patients suffering from chronic abdominal pain. This technique is also an effective treatment approach for pancreatic cancer patients who are suffering from nerve pain.

Cancer patients often struggle with severe pain and state that this aspect of the disease is the most distressing. Pancreatic cancer, in particular, is described as an extremely painful disease and, in most cases, conventional medication (e.g. opioids) are not effective at reducing the pain.

The structure known as the celiac plexus is comprised of a nerve bundle that is positioned in front of the diaphragm and directly behind the stomach. Approximately one to five ganglia are contained within the bundle. The abdomen sends signals to the ganglia that are transferred to the spinal cord and on to the brain. The celiac plexus block hinders this transfer from taking place and in doing so, reduces pain by preventing the abdomen from transmitting pain signals.

How is a Celiac Plexus Block Performed?

The celiac plexus block is performed under local anesthesia, but it is not a surgical procedure. The anesthetic that is injected onto the celiac plexus nerves prevent or block the nerves from transmitting sensory information (e.g. pain or temperature) to the brain.

Physicians utilize one of several procedures in order to administer the anesthetic to the celiac plexus nerve bundle. The most frequently performed method entails having patients lay on their abdomen. A local anesthetic is administered to the skin and then two small needles are inserted on both sides of the vertebrae that encase the nerve bundle. An X-ray or another imaging technique is utilized to ensure the proper placement of the needles in the celiac plexus. In order to further ensure proper positioning as well as to determine if the medication will be properly distributed throughout the targeted region, a contrast dye is injected through the needle before the anesthetic is administered. After the correct placement has been confirmed, the anaesthetic is injected into the celiac plexus nerve bundle.

A procedure known as a neurolytic celiac plexus block may also be performed, in which an anesthetic and alcohol are simultaneously injected in order to completely destroy the nerves that transfer pain signals. The ganglia within the celiac plexus are destroyed by the alcohol and instead of simply blocking the transfer of pain signals for a temporary period, this procedure completely disrupts signal transmission.

Celiac Plexus Block ProcedureA celiac plexus block is usually performed in 30 minutes and some patients experience an immediate reduction in pain. After the procedure, patients are taken to a recovery room and monitored for two to four hours in case any side effects develop.

If pain relief is not immediate, an improvement in symptoms typically begins during the first six to 24 hours following the nerve block. Several treatments are usually recommended in order to improve the outcome. It often takes multiple celiac plexus blocks for a patient suffering from severe abdominal pain to experience complete pain relief. Furthermore, the length of pain relief typically increases every time a patient undergoes the procedure. A single, neurolytic celiac plexus block can provide patients with a significant reduction or complete alleviation of pain for two months.

Conditions Related To Celiac Plexus Blocks

Reports indicate that a celiac plexus block is quite effective at reducing or alleviating abdominal pain that is associated with nerve inflammation and damage, or a visceral complication. Therefore, patients who are experiencing severe abdominal pain as well as those affected by pancreatic cancer generally respond very well to this form of pain treatment. Patients who have malignancies of the stomach, gallbladder, colon, or liver also tend to suffer from abdominal pain and experience pain relief from this nerve block.

A neurolytic block is not as common as the celiac plexux block and it is generally recommended for the treatment of pain that is caused by malignancies in the upper region of the abdomen and when opioids have been ineffective. However, the administration of neurolytic blocks for chronic abdominal pain that is not associated with a malignant condition has also been successfully performed for many patients.

Conclusion

The celiac plexus block is an effective treatment for the management of abdominal pain that does not require surgery. This procedure is especially useful for patients who have been taking opioids, but have not experienced significant pain relief or have tried conventional treatments that were also ineffective. There are minimal risks associated with this technique and some patients experience almost immediate pain relief. Furthermore, this nerve block can safely be repeated for patients who do not respond to the initial block and complete pain relief may occur after repeated treatments.

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References

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  2. Bektas M, Atiq M, Bhutani MS. First report of celiac plexus block for refractory abdominal pain secondary to peripancreatic colon cancer metastasis. Gastrointest Endosec. 2012;76(3):692-3.
  3. McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, Cohen SP. The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: A pilot study. Pain Pract. 2013;13(2):89-95.
  4. Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol. 2007;102(2):430-8.
  5. Zhong W, Yu Z, Zeng JX, Lin Y, Yu T, Min XH, Yuan YH, Chen QK. Celiac plexus block for treatment of pain associated with pancreatic cancer: A meta-analysis. Pain Pract. May 2013; [Epub ahead of print].
  6. Zou XP, Chen SY, Lv Y, Li W, Zhang XQ. Endoscopic ultrasound-guided celiac plexus neurolysis for pain management in patients with pancreatic carcinoma reasons to fight a losing battle. Pancreas. 2012;41(4):655-7.