Celiac Plexus Block
Procedure is performed for chronic intractable abdominal pain caused by:
- Pancreatic cancer
- Abdominal cancer
- Abdominal metastatic cancer
- Autonomic nervous system is one of the peripheral nervous system.
- Celiac plexus is sympathetic system of autonomic nervous system.
- The celiac plexus is also known as the solar plexus.
- Celiac plexus is located between T12 thoracic vertebrae and L1 lumbar vertebrae surrounds aorta.
- Plexus is formed by nerve fibers from vagus nerve,greater splanchnic nerve and lesser splanchnic nerves.
The celiac plexus includes a number of smaller plexuses:
- Hepatic Plexus – Nerves to liver
- Splenic Plexus – Nerves to spleen
- Gastric Plexus – Nerves to stomach
- Pancreatic Plexus – Nerves to pancreas
- Suprarenal Plexus – Nerves to adrenaline gland
- Renal Plexus – Nerves to kidney
- Testicular/Ovarian Plexus – Nerves to testicle or ovaries
- Superior mesenteric Plexus – Nerves to duodenum and small intestine
- Inferior Mesenteric Plexus – Nerves to large colon, cecum and anus
Sympathetic nerve fibers from celiac plexus innervates:
- Small and large intestine
- Adrenal glands
- Blood vessels
Celiac plexus lies behind and in front of aorta.
Celiac plexus lies anterior to Thoracic vertebrae T12 and Lumbar vertebrae L1.
Procedure: Patient is brought in the operating room. Advised to lie in prone position with pillow under abdomen. Patient is sedated with intravenous sedation if needed. Skin and subcutaneous tissue is anesthetized with local anesthesia. Local anesthesia used is lidocaine 1%. Lidocaine injected using 23 G needle. Total volume use is 2 to 3 ccs.
Procedure is performed using image intensifier (portable x-ray machine). Antero-posterior, lateral and oblique view use for needle placement.
Live intermittent and continuous x-ray pictures are view.
Needle is placed under anesthesia in front of aorta. Two Needles are place on each side: right and left side.
X-ray antero-posterior and lateral view is used for placing needle tip over celiac plexus. Aspiration test is performed to check aspiration of blood.
Dye study indicates dye is spreading in linear fashion in cephalic and caudal direction on both side.
Antero-posterior view and lateral (side) view is checked to confirmed the dye spread.
Celiac Plexus Block:
Aspiration test is performed to check needle placement in blood vessels.Medications injected at each side once all test are indicating needle is not in blood vessel.20 ccs of 0.5% Marcaine injected on each side. Needle gently removed.