Celiac Plexus Block

Overview

What is a celiac plexus block?

A celiac plexus block is a pain relief treatment delivered by injection. The treatment prevents celiac plexus nerves from sending pain messages to the brain. It’s a type of nerve block.

Healthcare providers use celiac plexus blocks to treat people who have pancreatic cancer or chronic pancreatitis. These conditions can cause severe abdominal pain.

What is the celiac plexus?

The celiac plexus is part of the nervous system. This bundle of nerves in the upper abdomen sits behind the pancreas close to the aorta, the body’s largest blood vessel.

Celiac plexus nerves send signals to the brain and spinal cord from digestive system organs, including the:

  • Gallbladder.
  • Intestines.
  • Liver.
  • Pancreas.
  • Stomach.

What does a celiac plexus block treat?

Healthcare providers use a celiac plexus block to ease severe abdominal pain caused by pancreatic cancer. Cancerous tumors can put pressure on the celiac plexus, causing pain.

People with chronic pancreatitis may also need a celiac plexus block to alleviate severe upper abdominal and back pain. Inflammation (swelling) of the pancreas causes pancreatitis.

What’s the difference between a celiac plexus block and a neurolytic celiac plexus block (neurolysis)?

With a celiac plexus block, a healthcare provider injects steroids or an anesthetic into the nerves. The medication provides temporary pain relief. When pain returns, you may need more treatments. Your provider may recommend this treatment if you have pancreatitis.

A neurolytic celiac plexus block, or neurolysis, permanently damages the celiac plexus nerves. Your provider injects an alcohol substance, such as ethanol or phenol, into the celiac plexus. The alcohol destroys the nerves, making them unable to send pain signals to the brain or spinal cord. Your provider may recommend this treatment if you have pancreatic cancer.

Procedure Details

When will I have a celiac plexus block?

For many people, a celiac plexus block is an outpatient procedure to relieve pain. You may have it at any point during treatment for pancreatic cancer.

Your provider may also perform a celiac plexus block during surgery or during an endoscopic ultrasound.

How should I prepare for a celiac plexus block?

You should follow your healthcare provider’s recommendations about what to do before the procedure. You may need to:

  • Stop taking certain medicines like blood thinners.
  • Fast (not eat or drink) before the procedure. Anesthesia is safer on an empty stomach.
  • Cut back on alcohol and quit smoking. These substances increase the risk of complications.

What happens during a celiac plexus block?

A nerve block procedure can take up to one hour, although the actual injections are often over in a few minutes. Celiac plexus block is an outpatient procedure, so you go home the same day. Someone will need to drive you home and should stay with you during the day.

The procedure typically takes place while you lie prone on your stomach with a bolster (pillow) underneath your hips. If it hurts too much to be on your stomach, you may be on your back (supine position). You will receive an intravenous medication (a sedative) to relax you.

Your healthcare provider will use imaging scans from fluoroscopy X-rays, a CT scan or endoscopic ultrasound to guide the procedure.

Your provider:

  • Sterilizes the treatment area with an antiseptic and numbs it with a local anesthetic.
  • Inserts a needle into the back and confirms correct needle placement by injecting a small amount of contrast dye, which shows up on the imaging scan. You may have some discomfort and feel a slight pinch.
  • Withdraws the needle and uses a different needle to inject a pain medicine (anesthetic) or steroid into the treatment area to numb the nerves.
  • Uses a different needle to inject alcohol into the celiac plexus (for a neurolytic procedure). The injection damages the nerves, preventing pain signals from traveling to the brain.

What happens after a celiac plexus block?

Most people get pain relief within 15 to 30 minutes after getting a nerve block. You’ll need to stay at the office for 1 to 2 hours to make sure you don’t have any complications.

Potential side effects may include:

Risks / Benefits

What are the potential risks or complications of a celiac plexus block?

A celiac plexus block rarely causes problems. When serious complications occur, they may include:

  • Allergic reaction to anesthesia or the contrast dye.
  • Decreased blood flow to the spinal cord.
  • Delayed emptying of stomach contents (gastroparesis).
  • Kidney damage or other organ damage.
  • Nerve damage.
  • Paralysis due to a spinal cord injury.
  • Seizures.

What are the benefits of a celiac plexus block?

People who have pancreatic cancer or pancreatitis may need a celiac plexus block to manage extreme abdominal pain. About 3 out of 4 people have significant abdominal pain at the time they receive a pancreatic cancer diagnosis. Eventually, this pain affects 9 out of 10 people.

Healthcare providers typically prescribe strong pain medicines to manage this pain. But these medications can cause uncomfortable side effects like confusion, constipation and nausea. With a celiac plexus block, you may be able to reduce the medication dose or amount.

Even with medicine, more than half of people still have pain. Periods of intense pain, called breakthrough pain, can occur. A celiac plexus block can decrease the frequency of breakthrough pain.

Recovery and Outlook

What is recovery like after a celiac plexus block?

Most people resume normal activities within 24 to 48 hours after the procedure. You shouldn’t drive or do any strenuous exercise or lifting for the first 24 hours.

How long does a celiac plexus block provide pain relief?

Pain relief from a nerve block varies by individual. Most people get 3 to 6 months of pain relief from a celiac plexus block. If pain returns, you can get another nerve block.

A neurolytic celiac plexus block damages the nerves to provide long-term pain relief. You generally won’t need another treatment.

When to Call the Doctor

When should I call the doctor?

You should call your healthcare provider if you experience:

A note from Cleveland Clinic

Pancreatic cancer can cause severe, chronic abdominal pain that can affect your quality of life. If pain medicines don’t provide adequate symptom relief or you have medication side effects, a celiac plexus block can help. The treatment damages the nerves, stopping them from sending pain signals to your brain. Your healthcare provider can discuss the pros and cons of this nerve block treatment with you.

Last reviewed by a Cleveland Clinic medical professional on 08/03/2021.

References

  • John RS, Dixon B, Shienbaum R. . [Updated 2020 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 8/17/2021.Celiac Plexus Block (https://www.ncbi.nlm.nih.gov/books/NBK531469/)
  • Kambadakone A, Thabet A, et al. . RadioGraphics. 2011;31:1599-1621. Accessed 8/17/2021.CT-guided celiac plexus neurolysis: A review of anatomy, indications, techniques and tips for successful treatment (https://pubs.rsna.org/doi/full/10.1148/rg.316115526)
  • Nitschke AM, Ray CE Jr. . Semin Intervent Radiol. 2013;30(3):318-321. Accessed 8/17/2021.Percutaneous neurolytic celiac plexus block (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773031/)
  • Pancreatic Cancer Action Network. . Accessed 8/17/2021.Celiac Plexus Block (https://www.pancan.org/facing-pancreatic-cancer/living-with-pancreatic-cancer/managing-side-effects-palliative-care/symptoms-pain/celiac-plexus-block/)
  • Radiological Society of North America. Nerve Blocks. Accessed 8/17/2021.
  • World Endoscopy Organization. . Accessed 8/17/2021.Tips and Tricks for Celiac Plexus Block/Neurolysis (https://www.worldendo.org/2018/01/17/tips-and-tricks-for-celiac-plexus-blockneurolysis/)

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