Splanchnic Nerve Block

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Splanchnic Nerve Block 2016-11-16T15:52:05+00:00

What Is A Splanchnic Nerve Block?

The pain and discomfort that accompanies cancer and its treatment has been noted to be one of the most distressing aspects of the condition. These symptoms can be quite severe and debilitating, leading to detrimental impacts on the patient’s functioning in terms of mood, energy, and willingness to complete necessary treatments. Moreover, it is not uncommon for cancer pain to be unresponsive to typical treatment techniques. For these patients, a more significant intervention for pain management may be warranted.

The splanchnic nerve block is a minimally invasive treatment option for patients suffering from severe and chronic symptoms of abdominal pain that do not require surgery. This treatment approach is non-surgical and effective in reducing or relieving symptoms of neuropathic pain in relation to pancreatitis, pancreatic cancer, and other conditions of the gallbladder, liver, stomach, small intestines, kidneys, and pancreas.

Originating from the 11th and 12th thoracic vertebrate, the splanchnic nerves extend down along each side of the spinal column. These splanchnic nerves terminate at the celiac plexus within the abdomen. Their primary function is to relay sensory and motor information from the abdominal region to the spinal cord and brain. During a splanchnic nerve block, these signals of pain that originate from within the abdomen are blocked before they can reach the spinal cord. Thus, this significantly reduces or even eliminates the patient’s subjective degree of pain severity.

How Is A Splanchnic Nerve Block Performed?

Splanchnic nerve blocks are an interventional method for managing pain. They are minimally invasive and do not require surgery. In fact, in many instances, splanchnic nerve blocks can be completed using only a topical local anesthetic.

Splanchnic nerve blocks effectively treat neuropathic pain originating from the abdominal region by impeding, or blocking, the transmission of pain information from the area to the spinal cord and brain. There are several methods by which this can be done. The most common technique employed requires that the patient be positioned lying face down. The injection site is thoroughly cleaned and sanitized. A fluoroscopic device is regularly used during the procedure to aid in correct placement of the injection needle.

For splanchnic nerve blocks, the needle is positioned into the 11th thoracic vertebrae. It is not uncommon for physicians to insert a contrast dye prior to injecting the anesthetic. This allows them to ensure that the needle has been properly placed, as well as provides the physician with an idea of the distribution area. Once the correct location of the injection needle has been verified, the physician will inject the anesthetic solution.

During neurolytic splanchnic blocks, alcohol is added to the anesthetic solution. While the anesthetic will effectively numb the area by temporarily inhibiting the function of the nerves, the alcohol will permanently destroy neural tissue.

In most cases, the procedure takes approximately 30 minutes to complete. Many patients will report relief from pain and discomfort almost immediately. In other instances, it may take several days before the patient experiences the full pain relieving benefits of the procedure. Once the splanchnic nerve block procedure has been completed, patients can expect to be monitored for any adverse reactions from the procedure or the medication before being discharged home.

As with most medical procedures, there is some risk associated with splanchnic nerve blocks. Following the procedure, some patients may experience a drop in blood pressure. Additionally, gastrointestinal distress is common. Symptoms of nausea generally resolve within a couple of hours. Patients can expect to have loose stools following a splanchnic nerve block.

Other side effects commonly reported following the procedure include:

  • Bleeding at the site of the injection
  • Slight bruising
  • Infection
  • Minor pain at the site of the injection
  • Temporary impairment in sexual functioning

Despite these side effects, many patients report significant benefits in reducing their pain and discomfort following splanchnic nerve blocks. In fact, a portion of patients can expect to remain pain-free for several years following the procedure. For patients who do not experience full relief from pain, repeat injections may be warranted. In these instances, evidence has suggested that the length of time the patient is pain-free increases following each injection.

Conditions Related To Splanchnic Nerve Blocks

Splanchnic nerve blocks are most commonly recommended for treating neuropathic pain that originates in the abdominal region. Moreover, patients who report pain and discomfort that has been unresponsive to previous treatment trials are considered ideal candidates for the procedure.

It is well known that patients suffering from pancreatic cancer endure the most severe symptoms of cancer pain. Splanchnic nerve blocks are often the ideal treatment option for managing this very severe and refractory pain. Other pain conditions affecting the stomach, pancreas, liver, gallbladder, kidneys, and small intestines are also regarded as ideal candidates for splanchnic nerve blocks.

Often used less commonly than traditional splanchnic nerve blocks, neurolytic blocks are generally reserved for patients suffering from malignancies of the upper abdomen. Further, physicians will want to ensure that the patient has undergone an unsuccessful trial of opioid medications prior to recommending the patient for a neurolytic block.

Conclusion

Splanchnic nerve blocks are a minimally invasive, non-surgical intervention for managing severe and refractory neuropathic pain originating from the abdomen. Patients are generally considered for splanchnic nerve blocks after they have undergone an unsuccessful trial of more conservative treatments. There are relatively few risks associated with the procedure and, in many cases, only a topical local anesthetic is required. Patients who are interested in whether this procedure is right for them are encouraged to speak with their doctor about the risks and benefits of splanchnic nerve blocks.

References

  1. Baghdadi S, Abbas MH, Albouz F, Ammori BJ. Systematic review of the role of thorascopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis. Surg Endosc. 2008;22(3):580-8.
  2. Bradley EL. Nerve blocks and neuroablative surgery for chonic pancreatitis. World J Surg. 2003;27(11):1241-8.
  3. Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23(5):512-22.
  4. Noble M, Gress FG. Techniques and results of neurolysis for chronic pancreatitis and pancreatic cancer pain. Curr Gastroenterol Rep. 2006;8(2):99-103.
  5. Saltzburg D, Foley KM. Management of pain in pancreatic cancer. Surg Clin North Am. 1989;69(3):629-649.
  6. Wong GY, Sakorafas GH, Tsiotos GG, Sarr MG. Palliation of pain in chronic pancreatitis. Use of neural blocks and neurotomy. Surg Clin North Am. 1999;79(4):873-93.
  7. Zheng Q, Qi L, Hu Y. Effect and clinical value of splanchnic nerve block of hemodynamics in ACST. J Tongji Medical Univ. 1997;17(3):182-186.

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