Celiac plexus block

Published on 07/02/2015 by admin

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Last modified 07/02/2015

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CHAPTER 220

Celiac plexus block

David P. Martin, MD, PhD

Indications

The celiac plexus provides sensory innervation and sympathetic outflow to most of the upper abdominal viscera (see Chapter 40). Neurolytic blockade of the celiac plexus is most commonly used to control pain caused by pancreatic cancer, although it can be useful for managing pain related to malignancies of the gastrointestinal tract from the lower esophageal sphincter to the splenic flexure, as well as the liver, spleen, and kidneys. Although potentially long-lasting, neurolytic celiac plexus block is not “permanent” because the nerves in the plexus regenerate in 3 to 6 months. The block can be repeated in such circumstances, but many patients with pancreatic cancer do not outlive the effective duration of neurolytic celiac plexus block. The median survival after diagnosis with pancreatic cancer is 3 to 6 months. Most patients with pancreatic cancer still require some oral analgesics even after neurolytic celiac plexus block.

Temporary diagnostic blockade of the celiac plexus can be used to differentiate visceral pain from somatic pain. Visceral pain is poorly localized and can be referred to somatic areas. For example, pancreatic pain often presents as epigastric tenderness radiating to the back. Relief of pain after celiac plexus block suggests a visceral origin of the pain. If pain persists after celiac plexus block, it is more likely to be somatic in origin. In addition to its neurolytic and diagnostic uses, celiac plexus injection with a local anesthetic agent and a corticosteroid is sometimes used to treat the pain associated with chronic pancreatitis.

Anatomy

The celiac plexus is primarily a sympathetic nervous system structure that lies anterior to the aorta near the celiac arterial trunk (Figure 220-1). Preganglionic sympathetic fibers originate from the nerve roots of T5-T12 and combine to form the splanchnic nerves. The splanchnic nerves cross the crura of the diaphragm before joining the vagus nerve to form the celiac plexus anterior to the aorta. The location of the plexus varies from T12 to L2 vertebral levels; approaches to the block are directed at the T12-L1 level.