What Is A Celiac Plexus Block?
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To start, it is not surprising that almost all cancer patients report that the pain is the most distressing aspect of their condition. Patients suffering from pancreatic cancer face the most severe and typically unremitting forms of pain. Treatment can be challenging for physicians, but it’s also painful and frustrating for patients. This type of pain can also be unresponsive to many types of treatment. One of the most effective treatments available for managing this pain, however, is the celiac plexus block.
Celiac nerve anatomy
The celiac plexus block is a non-surgical treatment option for managing chronic and refractory pain located in the abdomen. There is a bundle of nerves that lies close to the celiac artery underneath the stomach, but in front of the diaphragm. This bundle of celiac nerves can contain between one to five larger celiac ganglia. These, in turn, innervate the:
- Adrenal glands
These celiac nerves are responsible for monitoring large and vital parts of the body. But, they can also transmit pain information through them. A celiac plexus block effectively treats this abdominal pain because it blocks nerves that transfer information to the spinal cord and brain. And this is where we process pain sensations.
What Are The Benefits?This procedure provides a viable alternative to pain medications for many patients. In general, it:
- Does not require surgery
- Is minimally invasive
- Is typically is conducted with only a local anesthetic
- Can be done on an outpatient basis
For cancer patients that already experience long hospital waits and appointments, this can be a huge benefit in itself. But, the pain relieving benefits are real. In particular, a report in Seminars in Interventional Radiology notes that:
“Percutaneous neurolytic celiac plexus block (PNCPB) is an excellent treatment option for patients with intractable abdominal pain due to upper abdominal malignancies or chronic pancreatitis. In these patients, chronic refractory pain significantly decreases quality of life and often requires high doses of narcotics, which can lead to serious adverse side effects. PNCPB has been shown to have long-lasting improvement in abdominal pain and decreased narcotic usage in 70 to 90% of patients. In addition, with fewer than 2% of patients experiencing major complications, PNCPB is a quick, safe procedure.”
When performed by a highly-trained and specialized physician, this procedure can drastically improve an abdominal cancer patient’s quality of life.
Conditions Related To Celiac Plexus BlocksPrevious studies have provided ample evidence to support the use of the celiac plexus block to relieve severe and refractory nerve pain. The celiac plexus block targets pain within the abdomen in particular.
Patients most likely to receive benefit from receiving a celiac plexus block include those suffering from malignancies of the:
- Large colon
In particular, patients suffering from pancreatic cancer respond favorably to the procedure.
Neurolytic celiac plexus blocks, however, are not as common. This procedure, though, is also reserved for the treatment of pain and discomfort associated with malignancies of the upper abdomen. In these cases, the most appropriate use are for patients who have undergone previous failed treatment trials.
How Is A Celiac Plexus Block Performed?The procedure for a celiac plexus block can be done in several ways. The most commonly used method for performing a celiac plexus block starts with the patient lying down flat on their stomach.
You can also request an intravenous sedation medication in order to make the procedure more comfortable. If you choose to do so, your vital signs will be monitored closely, including body temperature, pulse rate, and blood pressure.
To start, the performing physician anaesthetizes the area using a topical anesthetic. This is applied to the surface of the skin in two different areas on the back.
One area is the location where an X-ray device is inserted. This allows the physician to guide the injection needle to the proper location. The second area is where the injection needle itself is inserted. In some cases, the physician may use contrast dye in order to confirm correct placement of the injection needle. Once the physician is certain that the needle is in the correct position, the anesthetic is injected.
For a neurolytic celiac plexus block, many physicians will also inject alcohol in addition to the anesthetic medication. The purpose of the alcohol is to destroy the tissue of the plexus nerves. As noted, these transmit pain information from the abdomen to the spinal cord and brain, thus temporarily impairing their function.
What Should I Expect After?In most cases, the celiac plexus block procedure takes less than 30 minutes to perform. Once the procedure is complete, the healthcare team transports patients to a recovery room where they are monitored for any adverse reactions. Patients can expect to spend anywhere from two to four hours in recovery before their physician discharges them.
Further, the Cleveland Clinic explains that after the procedure:
“Your abdomen may feel warm or ‘different,’ and you may begin to feel less abdominal pain. Your abdominal wall or leg may feel numb or weak, but this feeling will subside when the anesthetic wears off. You can continue your regular diet and medications immediately, but do not drive or do any rigorous activity for 24 hours after the procedure.”
As for pain relief? It may be instantaneous or within the first day. A proportion of celiac plexus block patients will report an almost immediate reduction of pain, though many patients do not experience pain relief for six to 24 hours.
If patients experience pain reduction, but still some of their symptoms, their pain specialist may recommend returning for more injections. This is because celiac plexus block injections are safe enough to be administered repeatedly. Thus, it is recommended that patients receive additional injections until they no longer report pain.
Patients receiving celiac plexus block injections can expect to experience relief from even severe and refractory forms of pain. Neurolytic celiac plexus block patients generally report around two months of pain relief.
Celiac Plexus Block Side Effects And RisksSome common side effects reported along with this procedure include transient diarrhea and hypotension.
As with most medical procedures, there is some risk associated with celiac plexus blocks though they are generally mild. In most cases, adverse effects occur from:
- Misplacement of the injection needle
- Puncturing a nearby organ
- Puncturing a neighboring blood vessel
Other adverse reactions may also include:
- Allergic reaction
- Pneumothorax (i.e., collapsed lung)
- Nerve damage
Working a specialist who has advanced experience performing this procedure can help mitigate your risks. You should also look for one who uses fluoroscopic guidance for the injection.
ConclusionThe celiac plexus block is a procedure used to treat severe and refractory forms of chronic pain in the abdominal region. The target of this treatment is to inhibit the function of the celiac ganglia, which is responsible for transmitting pain information from the peripheral nerves to the spinal cord and brain.
The procedure is non-surgical and minimally invasive. It typically takes place on an outpatient basis.
Even better, there are relatively few risks. Most patients report improvements in pain almost immediately–typically within 24 hours. Patients who do not achieve complete pain relief with the first injection may return for follow-up injections until they are completely pain free. Recovery from the procedure can take between two to four hours. Patients are also typically discharged the same day.
If you’re suffering from severe abdominal pain, it’s time to speak with a doctor about the risks and benefits of a celiac plexus block for managing your pain. This procedure can help you reduce reliance on narcotic pain medications as well as help you get back to your life.
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- 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.
- Rana, M. V., Candido, K. D., Raja, O., Knezevic, N. N. (2014). Celiac Plexus Block in the Management of Chronic Abdominal Pain. Current Pain and Headache Reports, 18(2). doi:10.1007/s11916-013-0394-z
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- 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].
- 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.