Overview of Celiac Plexus Block for Abdominal Pain

A celiac plexus block is a commonly performed procedure used to treat chronic abdominal pain, such as that associated with pancreatic cancer. This procedure offers long-term pain relief that last for 2-8 months.

What is the celiac plexus?

The celiac plexus is a bundle of nerves located behind the stomach, in front of the diaphragm, and near the celiac artery. This bundle of nerves supplies the pancreas, liver, gallbladder, spleen, stomach, intestines, kidneys, and adrenal glands. Blocking these nerves can relieve pain associated with any of these organs.

What conditions are treated with the celiac plexus block?

A celiac plexus block can alleviate the pain associated with any of the organs it supplies, such as the pancreas and liver. This treatment is often used for abdominal cancer pain, associated metastasis, and chronic cirrhosis pain.

How is the celiac plexus block performed?

One of the most common ways the celiac plexus block is performed is by the posterior approach. After lying down on your abdomen, the skin of the middle back region is cleaned using an antiseptic soap. The skin and deeper tissues is numbed using an anesthetic agent. The procedure needle is inserted to the side of the vertebrae, and advanced under real-time x-ray. After injecting a small amount of contrast dye, a local anesthetic is instilled onto the nerves. For additional benefit, the physician may inject a neurolytic agent (phenol or absolute alcohol), which destroys the nerves for additional pain relief long-term. Once the needle is removed, a bandage is applied to the injection site.

What are the benefits of the celiac plexus block?

Certain nerve blocks will help relieve painful conditions. The celiac nerve block improves or relieves pain associated with the abdominal cavity. The block is also a minimally invasive procedure, so there are few risks associated with it. Most patients are able to resume normal activities after this block, and many people report that they do not have to take as much pain medications.

Does the celiac plexus block work?

Many clinical studies have demonstrated the effectiveness of the celiac plexus block. In relation to terminal cancers, this block alone is capable of offering complete pain relief for many months, and it is often considered as an adjuvant pain treatment option. Pain from the abdominal organs is not easily treated with oral medications, so the celiac plexus block is an extremely useful therapy. In a recent research study involving patients with pancreatic cancer, the efficacy rate was found to be 75% during the first 3 months. In addition, researchers found that celiac plexus neurolysis provided effective pain relief and was a satisfactory treatment option.

Before this block, are there any specific things to do for preparation?

You will first meet with the pain management specialist to discuss your condition. You need to take a complete list of all your medications. Certain agents that thin the blood must be held for a few days before the procedure. Because a mild sedative is given before the procedure, you must not drink for 4 hours beforehand or eat for 8 hours prior to it. Arrange to have someone drive you home afterwards, as driving is not allowed for 24 hours. After the doctor reviews all procedure benefits and risks, you will sign a consent form.

What can I expect after the celiac plexus block?

Immediately after the celiac plexus block, you are monitored in the recovery room for around 45 minutes. Expect to have some soreness at the injection site. Pain relief may be immediate, as the anesthetic takes sudden effect. If a neurolytic agent is used, your pain will continue to improve over the next few days.

Resources

Rykowski JJ & Hilgier M (2000). Efficacy of neurolytic celiac plexus block in varying locations of pancreatic cancer: influence on pain relief. Anesthes, 92(2), 347-354.