Chemical neurolysis of the celiac plexus.
The celiac plexus consists 1-5 ganglia interconnected by a network of neural fibers, and is located in the upper abdomen between T12 and L2 vertebral bodies anterior the the aorta.
The celiac plexus is formed by sympathetic preganglionic and afferent fibers from T5-T12 splanchic nerves.
The splanchic nerves are composed of preganglionic sympathetic fibers to the upper abdominal viscera which synapse in the celiac ganglia and ascending afferent fibers which carry nociceptive signals from the pancreas, hepato-biliary organs, distal stomach, small bowel, large bowel as far as the transverse colon.
Highly effective treatment for upper abdominal visceral pain.
Utilized most commonly for pancreatic cancer and cholangiocarcinoma.
The procedure does not block somatic pain of the upper abdomen.
Neurolytic celiac plexus blockade provides 70-80% of patients immediate relief after the procedure and sustained reduction of pain in 60-75% of patients until death (Ischia S).
CT or fluoroscopy guided placement of needles in the vicinity of the celiac plexus is achieved and contrast media is injected to assure adequate placement, than local anesthetic is injected and it is determined after a few minutes if pain control occurs: If pain is relieved 70% alcohol, a neurolytic agent, is injected.
The procedure can be achieved by endoscopic ultrasound and intraoperatively.
Patients can experience mild pain at the site of injection for a number of days.
The procedure disrupts sympathetic innervation to the proximal small bowel, resulting in increased parasympathetic tone which can cause bowel hypermotility and diarrhea in 44% of patients (Eisenberg E).
As a result of loss of sympathetic tone following celiac plexus block splanchnic vasodilation may occur and intravascular fluid shift to the bowel and hypotension may occur (38%)(Eisenberg E).
Rarely transient or permanent loss of spinal cord function may occur if the neurolytic agent spreads to the spinal cord.
Serious neurologic sequelae occur with the procedure less than 0.2% of 2,730 neurolytic celiac plexus blocks (Davies DD).