The celiac plexus is located on both sides of the aorta at approximately the level of the first lumbar vertebra of your spine. Organs supplied with sensation from the celiac plexus include the stomach, liver, gallbladder, pancreas, kidneys and the gut as far as the transverse colon.
… Acute pancreatitis and chronic pancreatitis.
… Pancreatic cancer.
… Crohn's disease.
… Surgery of the upper abdomen.
… Acute or chronic, non-surgical, abdominal pain.
… Do not eat for 6 hours before block.
… Have a person designated as driver for you after block.
… Read and sign a consent form for the procedure, asking any questions at that time.
… Tell your doctor or nurse of any allergies you may have.
… An IV will be started and light sedation may be given.
… An EKG and blood pressure cuff will be placed and monitored before, during and after procedure.
… You will be placed on your abdomen with a pillow under your abdomen.
… Your doctor will draw out his anatomical landmarks using a skin marker on your back.
… The X-ray machine will be used to locate the landmarks.
… He will then numb two small areas of your back where the needles will be placed. This, in most cases, will be about as painful as having your skin numbed up before having your IV catheter placed.
… Some long-acting numbing medicine and in some cases, a cortisone preparation will be placed through the two needles. This will complete the procedure.
… Your back will be cleaned to remove the betadine soap solution.
… You will then be asked to turn over on your back to monitor vital signs more easily.
… After approximately 10-15 minutes, you may have something to drink if your vital signs remain stable.
… You will be observed for approximately 20-30 minutes after the block and then you will be discharged.
… Soreness at needle sites.
… Weak legs.
… Decreased blood pressure. (Orthostatic Hypotension)
… Pleural puncture. (punctured lung = Pneumothorax)
… Seizure.
… Chylothorax.
… Renal impairment.
… Paralysis due to injury to the Radicularis Magna (Artery of Adamkiewicz).
… Psuedoaneurysm of the abdominal aorta.
… Sleep on heating pad and take Tylenol should you develop soreness at needle insertion sites.
… Get up slowly from a reclining position so as not to feel dizzy should your blood pressure remain lower than usual after the block.
… Report any shortness of breath or difficulty in breathing immediately to your doctor or nurse at the pain program. If you are at home, go to your nearest emergency room and have the physician there give us a call.
Celiac plexus blocks are often done every 2-6 weeks for a total of three blocks. If, after 6-12 months, your doctor feels that another series may be beneficial, then it can be repeated.
Neurolytic Blocks
In the case of Pancreatic Cancer and other types of
abdominal malignancies, if this block proves to be effective in controlling the
pain, they can be repeated, using alcohol, phenol, or Radiofrequency, in an
effort to provide longer duration of relief. The duration of relief from these
longer lasting blocks will often outlive the patientís expected lifespan, hence
they are known as ěPermanent Blocksî. Their main advantage is that of providing
those patients with a significant improvement in quality of life, which is
often lost as the disease progresses and the patient gets closer to the end of
life. Most of the time, this occurs due to the use of strong narcotics that may
keep the patient oversedated, obtunded, and often disoriented. Contrary to
common belief, these treatments should not be used as ělast resortî. In fact,
the sooner they are used, the more effective they may be. Currently, ongoing
studies are looking at life expectancy issues, since some preliminary reports
have suggested that early intervention with these modalities may actually
increase the mean life expectancy on these patients.