by Nicole Berardoni M.D., Paul Lynch M.D., and Tory McJunkin M.D.

Celiac Plexus BlockA celiac plexus block is commonly performed for abdominal pain and especially effective for pancreatic cancer pain. The celiac plexus is a bundle of nerves located in front of the diaphragm and behind the stomach near the celiac artery and the abdominal aorta. The celiac plexus innervates the liver, pancreas, gallbladder, stomach, spleen, kidneys, intestines, adrenal glands, and blood vessels. Blocking this region can relieve pain caused by one of these organs. A celiac plexus block can be used to treat intractable pain from upper abdominal cancers. The most commonly and effectively treated cancer with celiac plexus blocks is pancreatic cancer and associated metastasis.

Procedure

Celiac-Plexus-PositionThe celiac plexus block can be performed in many ways. One of the most common ways to block the celiac plexus is the posterior approach. After lying down flat on your abdomen, your skin is anesthetized and a needle is inserted to the side of your vertebrae. The needle is advanced under X-ray guidance, and when the tip is in the correct position, a second needle is placed on the opposite side of the vertebrae. Contrast dye and local anesthetic are injected. A successful block is marked by profound pain relief. Your physician may also inject another medication, alcohol, or phenol that is used to destroy nerves for prolonged pain relief. The procedure usually takes less than 30 minutes. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure, temperature) after the procedure.

Benefits

Certain nerve blocks may help relieve pain conditions due to cancer. In patients with unresectable pancreatic cancer, nerve blocks are associated with improved pain control and reduced pain medication compared with standard treatment (Yan 2007). Celiac plexus blocks are a minimally-invasive treatment that effectively relieves severe pain for many people. The pain relief allows many people to regain the ability to resume their normal daily activities.

Risks

Celiac-Plexus-DiagramCeliac plexus blocks are considered an appropriate non-surgical treatment for many patients who suffer from severe abdominal pain. The risks for the procedure are typically low, but can include misplacement of the needle, bleeding, infection, pneumothorax (collapsed lung), puncture of surrounding organs, puncture of adjacent vessels, drug allergy, nerve damage, or paralysis. The most common side effects related to the procedure are hypotension and transient diarrhea.

Outcomes

Celiac plexus blocks are effective in relieving chronic abdominal pain, especially originating from malignancies of the pancreas, liver, gallbladder, omentum, mesentery, and alimentary tract from the stomach to the large colon (Erdine 2005). Pain from these areas is not easily treated by oral pain medications. When conservative treatments have been exhausted or side effects are experienced from oral medications, celiac plexus blocks are an extremely powerful option.

In relation to terminal cancers, celiac plexus block alone is capable of providing complete pain relief until death in many cases and, therefore, should be considered as an adjuvant pain treatment. Failure of the block may be due to tumor metastasizing outside of the celiac plexus innervation (Mercadante 1998). The benefits of celiac plexus blocks can be temporary for some people, and the amount and duration of pain relief vary from person to person. Some tend to have relief for weeks where others can benefit from the block for years. Fortunately, the procedure is a low-risk, non-surgical treatment that if successful the first time, will most likely continue to provide pain relief with repeat treatments.

If you are suffering with pain, contact Arizona Pain Specialists today to see if you can benefit from a celiac plexus block. We are happy to offer this exciting treatment option to patients in Scottsdale and the Phoenix metro area. Call today.

At Arizona Pain, our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

Journal Articles

  1. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Yan BM, Myers RP. Am J Gastroenterol. 2007 Feb;102(2):430-8. Epub 2006 Nov 13 PMID: 17100960
  2. Celiac ganglion block. Erdine S. Agri. 2005 Jan;17(1):14-22 PMID: 15791495
  3. Celiac plexus block: a reappraisal. Mercadante S, Nicosia F. Reg Anesth Pain Med. 1998 Jan-Feb;23(1):37-48