Coeliac Plexus Block
Pain sensation from organs in the upper part of the abdomen (the stomach, liver, pancreas and duodenum) are conveyed to the spinal cord via nerves that are part of the sympathetic nervous system. These are separate from those that carry sensation from the overlying skin and muscle around the abdominal wall. They pass back to the spinal cord via a network of nerves just in front of the big artery running down through the abdomen (the aorta) called the Coeliac plexus.
A procedure called a coeliac plexus block can be used to permanently numb the sensation carried in these nerves. This is usually used in the treatment of severe pain resulting from tumours in the organs supplied by the coeliac plexus, most often the pancreas.
The procedure is done under local anaesthetic with or without some sedation. With the patient lying on their front, under guidance from an X-Ray machine or sometimes a CT scanner, one or two fine needles are inserted just under the bottom of the ribcage and directed forward to lie just to either side of the aorta, in the area of the plexus (an alternative technique is to deliberately pass the needle through the aorta to end up just in front of it).
Once injection of X-ray dye confirms the correct position, local anaesthetic and then alcohol is injected to first numb and then kill the nerves.
This procedure has a good success rate in treatment of severe cancer pain from the pancreas and other organs supplied by the coeliac plexus. It is less effective for inflammatory conditions of the pancreas (chronic pancreatitis) and is rarely used for this.
It does have some side-effects: there is a potential to cause bleeding from the local blood vessels, and the effect on the nerves can lead to a tendency for the blood pressure to drop on standing up in the first few days. Sometimes it can also lead to diarrhoea after the procedure. Very occasionally it can lead to temporary weakness of the legs afterwards, and in a very tiny number of cases this weakness can be permanent.
Another possible technique for doing a coeliac plexus block is using endoscopic ultrasound (EUS). An endoscope is passed from the mouth down into the stomach and duodenum, and through this an ultrasound probe is passed down the endoscope to produce a picture of the coeliac plexus next to the duodenum on a monitor. A needle is then passed down the endoscope guided by the utrasound images to inject alcohol into the plexus to deaden its nerves.
(Please see general comments on the Procedures page: for coeliac plexus block with alcohol for cancer pain we would normally arrange for patients to stay in hospital to be observed for the night afer the procedure)
A technical description of the procedure is given on the Anaesthesia UK website
The Trust's information sheet on Coeliac Plexus Block can be downloaded here
An article about the evidence for neurolytic coeliac plexus block on the Bandolier evidence-based medicine website, and there is also detailed discussion of this procedure in a paper written by Dr de Courcy.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 22/6/2016