CELIAC PLEXUS BLOCK

The celiac plexus block (CPB) is the most useful of all the nerve blocks. (see Nerve Blocks)

Indications:

1. Visceral abdominal pain uncontrolled by correct doses of morphine (mainly in carcinomas of the stomach, pancreas or liver)

2. Severe colic due to malignant intestinal obstruction (rarely indicated)

3. Intractable nausea (rarely indicated)

CPB is a very successful technique, and at least 90% of patients get good pain relief, following which morphine can be reduced or stopped altogether. Its effect is usually permanent.

Technique – CPB is performed under sedation and local anesthetic, and x-ray control is necessary to position the needles. The 15cm needles are inserted 7cm from the midline, below the 12th rib. The plexus lies behind the peritoneum, at the level of L1, just anterior to the aorta (which is just anterior to the body of the L1 vertebra). 10ml of neurolytic (phenol or absolute alcohol) preceded by 10ml of 0.5% bupivacaine, is injected. Absence of post-block postural hypotension indicates failure of the technique. CPB can also be performed at open laparotomy provided the plexus is not obscured by tumor, or via an anterior approach under CT scan control.

Side effects of CPB:

•  Postural hypotension for 1 to 2 days

•  Increased gut motility

•  Backache for 24 hours

•  Loss of ejaculation (sometimes)

Potential complications (as follows) are rare:

•  Hematoma (from aorta or IVC)

•  L1 neuritis (numbness of anterior thigh)

•  Pneumothorax

•  Paraplegia (injection into spinal artery)

•  Sudden death

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.