Celiac Plexus Block in the Management of Chronic Abdominal Pain

• Published in: Current pain and headache reports Vol. 18; no. 2; p. 394
• Main Authors: Rana, Maunak V., Candido, Kenneth D., Raja, Omar, Knezevic, Nebojsa Nick
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-02-2014; Springer Nature B.V
• Subjects: Abdomen; Abdominal Pain - drug therapy; Abdominal Pain - etiology; Abdominal Pain - physiopathology; Anesthetic Techniques in Pain Management (D Wang; Anesthetics, Local - administration & dosage; Autonomic Nerve Block; Bupivacaine - administration & dosage; Celiac Plexus - anatomy & histology; Celiac Plexus - drug effects; Celiac Plexus - physiopathology; Chronic Disease - drug therapy; Endoscopy; Endosonography; Female; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Pain; Pain Measurement; Pain Medicine; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - physiopathology; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - drug therapy; Pancreatitis, Chronic - physiopathology; Patient Selection; Section Editor; Tomography, X-Ray Computed; Topical Collection on Anesthetic Techniques in Pain Management; Treatment Outcome; Triamcinolone - administration & dosage; Ultrasonic imaging; Chronic abdominal pain; Chronic pancreatitis; Celiac plexus block
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-013-0394-z

Chronic abdominal pain is a devastating problem for patients and providers, due to the difficulty of effectively treating the entity. Both benign and malignant conditions can lead to chronic abdominal pain. Precision in diagnosis is required before effective treatment can be instituted. Celiac Plexus Block is an interventional technique utilized for diagnostic and therapeutic purposes in the treatment of abdominovisceral pain. The richly innervated plexus provides sensory input about pathologic processes in the liver, pancreas, spleen, omentum, alimentary tract to the mid-transverse colon, adrenal glands, and kidney. Chronic pancreatitis and chronic pain from pancreatic cancer have been treated with celiac plexus block to theoretically decrease the side effects of opioid medications and to enhance analgesia from medications. Historically, the block was performed by palpation and identification of bony and soft tissue anatomy; currently, various imaging modalities are at the disposal of the interventionalist for the treatment of pain. Fluoroscopy, computed tomography (CT) guidance and endoscopic ultrasound assistance may be utilized to aid the practitioner in performing the blockade of the celiac plexus. The choice of radiographic technology depends on the specialty of the interventionalist, with gastroenterologists favoring endoscopic ultrasound and interventional pain physicians and radiologists preferring CT guidance. A review is presented describing the indications, technical aspects, and agents utilized to block the celiac plexus in patients suffering from chronic abdominal pain.