Shivam
Pain Management
Centre
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Celiac Plexus Block

 

Anatomy

  • The celiac plexus is also known as the solar plexus.
  • It is the main junction box for autonomic nerves supplying the upper abdominal organs (liver, gall bladder, spleen, stomach, pancreas, kidneys, small bowel, and 2/3 of the large bowel).

Indications

  • Acute Pain - may be performed during surgery to assist with pain relief afterwards.
  • Chronic Pain - useful for any condition that causes chronic severe upper abdominal visceral pain e.g. chronic pancreatitis
  • Cancer Pain - useful for upper abdominal organ cancer pain, and is frequently used for carcinoma of the pancreas.

Technique

  • The block is performed using X-ray screening/CT guidance, intravenous sedation , local anaesthetic infiltration of the superficial layers, with the patient in the prone position .
  • Intravenous fluids (plasma expanders 1000 ml) are required pre-block to reduce the risk of the blood pressure falling afterwards.
  • It normally takes two needle insertions, one on each side to block both of the celiac plexus
  • The needle entry point is just below the tip of the 12th rib , and using X-ray screening in two planes, the needle is advanced until it hits the side of the L1 vertebra.
  • The needle is withdrawn slightly and then re-directed forwards until it is in the area of the celiac plexus, avoiding the aorta (main down pipe from the heart) and inferior vena cava (main up pipe to the heart).
  • Radio-opaque dye is injected to confirm the correct placement of the needle, and then the appropriate mixture is injected:-

Complications

  • Bleeding due to aorta or inferior vena cava injury by the needle.
  • Intravascular injection (should be prevented by checking the needle position with radio-opaque dye).
  • Upper abdominal organ puncture with abscess / cyst formation.
  • Paraplegia from injecting phenol into the arteries that supply the spinal cord (should be prevented by checking the needle position with radio-opaque dye).
  • Sexual dysfunction (occurs when the injected solution spreads to the sympathetic chain bilaterally).