Celiac plexus block

What is it:

The celiac plexus is situated retroperitoneally in the upper abdomen. It is at the level of the T12 and L1vertebrae, anterior to the crura of the diaphragm. The celiac plexus surrounds the abdominal aorta and the celiac and superior mesenteric arteries. The plexus is composed of a network of nerve fibers, from both the sympathetic and the parasympathetic systems. It contains two large ganglia that receive sympathetic fibers from the three splanchnic nerves (greater, lesser, and least). The plexus also receives parasympathetic fibers from the vagus nerve. Autonomic nerves supplying to the liver, pancreas, gallbladder, stomach, spleen, kidneys, intestines, and adrenal glands, as well as blood vessels, arise in the celiac plexus.

Purpose:

A celiac plexus block is used for pain control. This procedure blocks the nerves which come from the pancreas, liver, gall bladder, stomach and intestine. A celiac plexus block consists of injections of a local anesthetic, steroid or ethy-alcohol (phenol). The use of alcohol, called a neurolytic block, destroys the nerves. A trial block is done, using a local anesthetic, before a neurolytic block is performed. If you get short term pain relief from the local anesthetic then a neurolytic block is done.

How is it Done:

A celiac plexus block is done in the CT scan room. You will be asked to lie face down on the CT scan table. An IV will be started. Using x-ray guidance, a needle is advanced to the correct location. The local anesthetic, with or without the steroid, is injected and the needle is removed. The procedure takes about 30 minutes.
Three approaches to block nociceptive impulses from the viscera of the upper abdomen include theretrocrural (or classic) approach, the anterocrural approach, and neurolysis of the splanchnic nerves. With all of these approaches, the needles are inserted atthe level of the first lumbar vertebra, 5 to 7 cm from the midline. Then, the tip of the needle is directed towards the body of L-1 for the retrocrural and anterocrural approaches and to the body of T-12 for neurolysis of the splanchnic nerves. More recently, computed tomography and ultrasound techniques have allowed pain specialists to perform neurolysis of the celiac plexus via a trans abdominal approach. This approach is frequently used when patients are unable to tolerate either the prone or lateral decubitus positionor when their liver is so enlarged that a posterior approach is not feasible.
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