CELIAC PLEXUS BLOCKS AND NEUROLYSIS

Indications

Treatment of intractable abdominal pain treatment of intractable intra-abdominal pain, including pain in the setting of malignant and benign neoplasms. It is used to treat abdominal pain in gallbladder cancer, stomach cancer, liver cancer & pancreatic cancer patients. Patients with advanced cancer often have intense abdominal pain. They often use strong pain medicines, such as opioids, to control this pain.Even patients who use pain medicines may still have breakthrough pain, or periods of intense pain. Additionally, pain medicines can also cause uncomfortable side effects, like constipation. A celiac plexus block can help a patient avoid breakthrough pain. The block usually does not stop all the pain. But it may lessen the need to use pain medicines.

Procedure

The celiac plexus is a nerve bundle in the upper abdomen. It is located behind the pancreas and near the aorta. The celiac nerves connect the pancreas, gall bladder, intestines, liver and stomach to the brain and spinal cord. Tumors from these organs often cause pain by pressing on and injuring these nerves.

A celiac plexus block is a procedure that damages the celiac nerves so they cannot send pain messages to the brain.

In the fluoroscope guided celiac plexus block patient is placed face down on a procedure table and typically IV sedation is used along with numbing medicine through the skin and soft tissues. Vital signs will be monitored.

The area to be injected is cleansed with antiseptic solution and numbed with a topical anesthetic. A needle is inserted on one or both sides of the spine with the aid of a fluoroscope (a type of x-ray machine) to ensure proper placement of the needle. Usually it's two sides to ensure the best chance for pain relief.

Contrast dye will be injected into the area to ensure the medications will go to the desired area and placement is satisfactory. After the contrast dye ensures proper placement of the medication a mixture of local anesthetic and corticosteroids are injected into the area. For cancer patients we inject 6-10% phenol or 50-100% alcohol to neurolyse the celiac plexus for long term pain relief.

The celiac plexus block procedure takes 30-60 minutes. The total procedure time depends on how the doctor accesses the celiac nerves. Most patients feel some, although not total, relief from pain after the procedure. Since the nerve block typically lasts three to six months, patients may need to repeat the procedure.

Special Instructions

Minimum of six hours of fasting is required before the procedure but clear instructions will be given to you with regards to this before your admission. You will be offered a drink after the procedure when you have come back to the ward from recovery. Take your usual medication and bring your medications with you. Patients taking warfarin/ Clopidogrel/ Aspirin will be given individual information as these medications need to be stopped few days before procedure.

Side Effects And Complications

Complications related to a celiac plexus block are rarely serious. The procedure is not recommended for patients taking blood-thinning medicines or who have an infection or bowel blockage.

Common side effects include: