A bundle of nerves located near the aorta and behind the pancreas is sometimes responsible for abdominal pain caused by chronic pancreatitis or pancreatic cancer.
One way this type of discomfort may be managed is with a lumbar sympathetic block (LSB). Specifically, this type of injectable block targets nerves found on both sides of the spine in the lower back area. Sympathetic nerves begin in the vertebral column and continue into the second or third lumbar segments. The goal with injections is to reduce inflammation and ease nerve irritation.
What Is a Celiac Plexus Block?
A celiac plexus block targets abdominal nerves that connect to several important structures, such as the intestines, gall bladder, pancreas, and liver. These nerves also link to the spinal cord and, eventually, the brain. Pancreatic tumors sometimes irritate or compress these nerves. Other sources of abdominal pain may also be treated with this type of nerve block under the right circumstances.
Why Consider This Type of Block?
Abdominal pain is sometimes experienced as breakthrough pain, referring to intermittent periods of intense pain. Managing this type of discomfort often requires the use of opioid painkillers, some of which have potentially serious or uncomfortable side effects such as constipation. A celiac plexus block may not stop all abdominal pain, but it could help ease your reliance on medication while also minimizing instances of breakthrough pain.
How Is a Celiac Plexus Block Given?
A celiac plexus block can be administered directly through the skin. An endoscopic ultrasound (EUS) may also be used to provide guidance for the needle. It’s also possible to administer this type of block during surgery. If it’s injected, live X-ray guidance may also be used to help with needle guidance. A contrast material might be used as well to confirm that the medication is reaching the celiac plexus nerves. Pain-relieving medication used for a celiac plexus block may include:
- Steroid mediation
- Epinephrine (adrenaline)
- A synthetic version of a neurotransmitter produced by the adrenal glands
- Clonidine
- Alcohol or phenol to destroy nerves sending pain signals
What Happens After the Procedure?
It takes somewhere around half an hour to an hour to complete the procedure. There may be some degree of immediate relief after the celiac plexus block is given. This is usually due to the anesthetic that’s also included with the injection. There could be a slight uptick in abdominal discomfort until the medication injected in the block takes full effect.
Gaining better control over abdominal symptoms may make it easier to benefit from other treatments for pancreatic cancer or similar sources of abdominal discomfort. Patients tend to benefit more from celiac plexus blocks when this pain management option is explored soon after a tumor or other source of abdominal pain is discovered. Results from blocks of this nature typically last from 3-6 months. If the procedure is effective, it may be repeated as the effects start to wear off.
If you are on blood-thinning medications or have a bowel blockage, a celiac plexus block may not be right for you. Possible side effects may include tenderness or swelling around the injection site, diarrhea, and low blood pressure. But if you are considered an ideal candidate for this procedure and pain medication and other pain management techniques aren’t effectively managing your abdominal pain, you may respond well to a celiac plexus block.