Celiac Plexus Block



Celiac Plexus Block


Lubdha M. Shah, MD










Coronal graphic depicts the right image and left image celiac ganglia, superior mesenteric ganglion image, & splanchnic nerves (T5-T12) image. The CP extends from T12 to mid L2 and can be defunctionalized with neurolytic medications.






Axial NECT demonstrates needle tip with contrast in the sympathetic plexus ganglia image. CT outlines the anatomy & tumor burden; it allows precise needle placement & better delineation of injectate spread.


TERMINOLOGY


Abbreviations



  • Celiac plexus block (CPB)


Synonyms



  • Splanchnic plexus block/neurolysis


  • Periaortic sympathetic plexus block/neurolysis


Definitions



  • Palliative procedure in cases of severe upper abdominal pain caused by pancreatitis or advanced cancers of the upper abdominal viscera, especially pancreatic cancer



    • Blocks transmission of pain by treating celiac plexus (CP) with a neurolytic agent, such as alcohol


    • Can be guided by bony landmarks, fluoroscopy, ultrasound, CT, MR, or endoscopic ultrasound


Anatomy



  • Abdominal visceral pain is mediated through nerve fibers that travel from the viscera → celiac ganglia → splanchnic nerves



    • CP: Autonomic efferents (supply upper abdominal viscera) & visceral afferents (supply abdominal viscera from distal esophagus to transverse colon)


    • Block at ganglion level: Afferents innervating abdominal & pelvic organs travel in/along sympathetic nerves, trunks, ganglia, & rami


    • Splanchnic nerve blocks will affect only sympathetic efferent and afferent pathways


  • CP consists of 1 to 5 pairs of ganglia ranging in size from 0.5-4.5 cm: The celiac, the aortic-renal, and the superior mesenteric



    • Variable location of CP with regard to bony landmarks; more reliably found close to ostia of celiac artery



      • ˜ 0.6 cm caudad to celiac artery on right and 0.9 cm caudad to celiac artery on left


  • Retro- and anterocrural space is well-defined anatomic compartment that restricts spread of neurolytic agent



    • 3 components: Aorta, crura of diaphragm, vertebral body


PRE-PROCEDURE


Indications



  • Severe chronic abdominal pain due to advanced cancers of the upper abdominal viscera, especially pancreatic cancer



    • Blocking transmission of pain with a neurolytic agent, such as alcohol, can decrease the need for opiates and limit opioid side effects, especially constipation


    • Alcohol destroys nerves by dissolving their fatty sheaths but has little effect on other nearby structures such as the muscular wall of the aorta


Contraindications



  • Uncooperative patient


  • Coagulopathies


Getting Started

Sep 22, 2016 | Posted by in EMERGENCY RADIOLOGY | Comments Off on Celiac Plexus Block
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