Celiac plexus block is widely used to treat chronic abdominal pain traced to cancer in the abdominal area or pancreatitis. Found to be effective for those not responding to oral medication, the block therapy provides respite from intractable abdominal pain, high-dose narcotic pain killer medication without any major complications.
What is celiac plexus block?
Celiac plexus block refers to preventing innervations of nerves spread in the upper abdomen area and interrupting pain-signal carrying nerve fibers using numbing injections. Celiac plexus, a hub of nerves located in the abdomen below the diaphragm, provides somatic sensory signals to nerve fibers connecting liver, pancreas, stomach, gallbladder, kidney and other organs in the abdomen.
Numbing medication injected during celiac plexus block inhibit the ability of nerves carrying pain signal from abdomen to the brain. As a result, patients experience significant pain relief for weeks at a stretch.
What is injected during a celiac plexus block?
The injection usually contains local anesthetic, such as lidocaine. Often this is combined with steroid or alcohol for superior effect. To make the pain relief extended, epinephrine or clonidine may be added.
What is a diagnostic celiac plexus block?
The diagnostic celiac plexus block is performed to know if the block is beneficial for a particular patient. An injection containing only a local anesthetic is administered to the plexus. A patient experiencing at least 60 percent pain relief is deemed fit for the next step – neurolytic celiac plexus block.
What is a neurolytic celiac plexus block?
Once the diagnostic celiac plexus block proves to be success, this stage of the procedure is performed for longer and better pain relief. Steroid or alcohol is mixed to the numbing medication injected.
What conditions are treated using a celiac plexus block?
Celiac plexus block is useful to treat chronic abdominal pain associated with
- cancer affecting the organs in the abdomen
- serious and severe abdominal disorder
- severe intractable pelvic pain
When is a celiac plexus block required?
A patient is advised to go for celiac plexus block when the oral pills and other modes of treatment fail to inhibit chronic abdominal pain and provide significant pain relief.
How beneficial is celiac plexus block?
- Celiac plexus block is found to provide pain relief between a few weeks and a year subject to patient conditions.
- The procedure significantly reduces the dependence on pain medication while improving the quality of life.
- According to a study, complete relief from pain symptoms were visible in over 50 percent of patients treated with the procedure. (Regional Anesthesia and Pain Medicine, 1998)
- Another study discovered significant relief and lowered opioid painkiller medication use after the injection. (Pain, 1993)
- An analysis of 24 studies concludes that celiac plexus block has 90 percent success rate. (Anesthesia & Analgesia, 1995)
- The procedure relieves chronic abdominal pain due to “malignancies of the pancreas, liver, gallbladder, omentum, mesentery, and alimentary tract from the stomach to the large colon.” (Erdine 2005)
- Celiac plexus block is beneficial for 73 to 85 percent of patients with pain from pancreatic cancer. (American Journal of Gastroenterology, 2007)
- The procedure reduces dependence on nacrotic drug use by 70 to 90 percent. (Radiographics, 2011)
How is celiac plexus block done?
An intravenous medication may be administered to patients and they are asked to lie down on their stomach for celiac plexus block to be performed. Doctors use a local anesthetic to numb the targeted area and deep tissues under it.
A needle is inserted next to the vertebrae under fluoroscopic guidance. Another needle is put from the other side of the vertebrae and contrasting dye is injected to confirm the location of the plexus. Then, the pain medication (mixture of lidocaine, streroid/ alcohol, and epinephrine) is injected to perform the block.
How long does it take?
It takes about 30 minutes.
What should I expect after the procedure?
Patients are monitored for a while for potential side effects and provided intravenous fluid prior to they are allowed to go home. They may experience low blood pressure for two to four hours following celiac plexus block. Patients may experience irritation for up to seven days.
How many celiac plexus block injections should I have?
A patient needs a series of injections to have continued relief from chronic abdominal pain. The total number of injections for celiac plexus block and gap between two injections depend on patients’ response to the treatment.
When will I have pain relief?
Pain relief can be felt immediately and celiac plexus block benefits are most visible in a day or two.
How long does the pain relief last?
The diagnostic or testing celiac plexus block lasts for 24 hours while the neurolytic or the actual celiac plexus block for pain relief from a few weeks to a year based on patient conditions. The block assures relief for pain for at least two months.
What are the side effects of celiac plexus block?
Celiac plexus block may lead to injection site inflammation, soreness, diarrhea and low blood pressure. Unless administered by an expert, patients are likely to experience damage to blood vessels and collapsed lung.
Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol. 2007 Feb;102(2):430-8.
Mercadante S, Nicosia F. Celiac plexus block: a reappraisal. Reg Anesth Pain Med. 1998 Jan-Feb;23(1):37-48
Rana MV, Candido KD, Raja O, Knezevic NN. Celiac plexus block in the management of chronic abdominal pain. Curr Pain Headache Rep. 2014 Feb;18(2):394.
Yamamuro M1, Kusaka K, Kato M, Takahashi M.Celiac plexus block in cancer pain management. Tohoku J Exp Med. 2000 Sep;192(1):1-18.
Polati E, Luzzani A, Schweiger V, Finco G, Ischia S.The role of neurolytic celiac plexus block in the treatment of pancreatic cancer pain. Transplant Proc. 2008 May;40(4):1200-4.