Celiac Plexus Block

Blockade of the celiac plexus is classically indicated to treat visceral pain of malignant origin. In particular, pain due to pancreatic cancer responds very well to celiac plexus blockade. The autonomic innervation to the majority of abdominal organs flows through the celiac plexus. This includes the pancreas, liver, gallbladder, omentum, mesentery, stomach, small intestine, and the ascending and transverse portion of the colon. The descending colon, rectum, and pelvic viscera are not innervated through the celiac plexus.

The block was first described by Kappis in 1914. It is performed with the patient in the prone position, at the level of the L1 vertebral body. A number of variations exist on the technique, with some even transversing the aorta to reach the celiac plexus. Basically, the plexus lies anterior to the L1 vertebral body. Needles are placed approximately 5-7 cm lateral to the midline, and advanced under flouroscopic guidance to lie anterior to the vertebral body. A test block is usually performed with local anesthetic to ensure benefit from the procedure. If the patient achieves good pain relief from the local anesthetic, a neurolytic block, with either alcohol or phenol, is then performed.

Complications related to celiac plexus can be serious, so exntensive discussion takes place as to the risks and benefits of the procedure. The most serious complication is paralysis, due to spread of the neurolytic agent into the spinal or epidural space, or due to damage of the main arterial supply to the spinal cord, (i.e., the artery of Adamkiewicz). Other complications include hypotension, accidental intraarterial injection, diarrhea, and damage to the kidneys . It is contraindicated in the presence of systemic anticoagulation, sepsis or local infection, as well as bowel obstruction. The transarterial approach is illustrated below.