FAQ’s on Celiac Plexus Block in Philadelphia

A celiac plexus block (CPB) is used for the management of severe, intractable abdominal pain. This procedure allows the doctor to inject medication onto nerves to block pain signal transmission.

What conditions can be treated with a celiac plexus block?

CPB is used to manage pain related to pancreatic cancer, abdominal cavity cancer, chronic pancreatitis, abdominal visceral pain syndrome, cholangiocarcinoma, retroperitoneal malignancies, biliary sphincteric disorder, and chronic abdominal pain. Visceral (organ) pain related to malignancy is difficult to treat, and this pain is often unresponsive to oral pain relievers.

What is the celiac plexus?

The celiac plexus is a bundle of nerves located behind the stomach, near the abdominal aortic blood vessel, which supplies the organs of the abdomen. These organs include pancreas, liver, gallbladder, spleen, kidneys, adrenal glands, and stomach. The plexus is a complex network of nerves and small nerve cells that carry pain signals from the internal organs to the brain.

What should I expect before the procedure?

You will need to bring someone to drive you home, because a sedative may be given. When you arrive at the medical center, a member of the staff will go over all the benefits and risks, and you must sign a consent for services form. An IV catheter will be placed in your arm, and monitoring devices will be attached to assess blood pressure, pulse, and oxygen level.

How is the celiac plexus block performed?

The most common approach to this block is called the posterior approach. The patient is positioned on his/her stomach and draped. The doctor numbs the skin of the back using an anesthetic, and once numb, inserts a needle near the nerves using radio-contrast dye and diagnostic imaging to ensure correct placement. The long-acting anesthetic and/or neurolytic agent in injected onto the nerves. The entire procedure only takes around 30 minutes.

What happens after the celiac plexus block procedure?

You will be moved to a recovery area where a nurse will monitor your vital signs and pain for 20-30 minutes. Expect to have a little soreness at the injection site, which resolves after a short while. The nurse will give you discharge instructions, and you should rest for the remainder of the day. You can return to usual activities after a few days.

What are the benefits of the procedure?

Celiac plexus nerve blocks are associated with reduced reliance on pain medicine, as well as improved pain control. Many patients are able to resume usual activities of daily living. Research shows that there is a high certainty of moderate pain relief, but the character and duration of relief varies from person to person. Some studies show that the CPB is more effective when performed soon after the initial onset of pain. In addition, this procedure is minimally invasive with few risks.

What complications and risks are associated with this procedure?

No medical procedure comes without risks. However, the risks rarely occur with the celiac plexus block. These include possible needle misplacement, puncture of abdominal organs, nerve damage, bleeding, drug reaction, and collapsed lung.

What side effects are associated with the celiac plexus block?

All blocks have some type of side effect. With the celiac plexus block, side effects include diarrhea, back pain, and low blood pressure. However, not every patient experiences these side effects, and they are only temporary.

Does the celiac plexus block work?

According to a large review of studies, CPBs allow patients to achieve excellent pain relief. The efficacy rate was reported at between 85 to 90 percent. The pain control usually lasts for several months, and the procedure can be repeated as necessary. In addition, the celiac plexus block allows terminal patients to have improved mobility and function for the remainder of their lives.

 

Resources

Levy, M., & Wiersema, M. (2012). Endoscopic ultrasound-guided celiac plexus and ganglia interventions. Retrieved from UpToDate.

 

Mercandante, S., & Nicosia, F. (1998). Celiac plexus block: a reappraisal. Regional Anesthesia Pain Medicine, 37-48.
Yan, B., et al. (2007). Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. American Journal of Gastroenterology, 37-48.