This is an injection to control pain due to the spread of cancer in the organs of the upper abdomen. The celiac plexus block is a group of nerve fibers coming from the pancreas, stomach, liver, and part of the bowels. It is located in the center of the abdomen, underneath the diaphragm. We inject these nerve fibers with a numbing medicine to interrupt the nerve fibers, and decrease the feeling of pain.
You should not eat after midnight and only have something clear (water, tea or coffee without milk) to drink up to three hours prior to the procedure. You should take all your medications with a sip of water at the scheduled time. This also includes your pain medications.
In the Interventional Pain Clinic an anesthesiologist will assess your pain, take a brief medical history and perform an exam focused on your pain symptoms. After the initial visit, you will often get two appointments. One appointment is for a diagnostic block, and one for a neurolytic, long-term celiac plexus block. The risks and benefits of the procedure will be discussed, and your questions answered.
For the diagnostic celiac plexus block we will use only numbing medicine (local anesthetic). This will show us if this block will relieve at least 60 percent of your pain. If this block helps to relieve some of your pain we then will perform the longer lasting neurolytic celiac plexus block.
For the neurolytic celiac plexus block we will use a concentrated alcohol with some numbing medicine. In contrast to the numbing medicine the alcohol will actually destroy the nerve fibers. These destroyed nerve fibers will not be able to let you feel the pain for a much longer time.
We will start an intravenous line for the administration of some medications during the procedure to make you comfortable. For the celiac plexus block you will lie on your belly. The procedure will be done under sterile conditions. The anesthesiologist will numb a small area of your skin on two areas in the middle of your back. She or he will then advance two small needles to the area between the spine and the big abdominal artery. During the injections of the medicine you might feel a slight burning sensation. After the injection you will be escorted to the recovery room where you will remain for two to four hours.
You will have immediate relief of pain. After the neurolytic celiac plexus block you might experience some more discomfort after the first day for about up to seven days. This is from the alcohol which sometimes irritate structures in your abdomen.
The diagnostic block will give you good pain relief for six to 24 hours. The neurolytic celiac plexus block will usually give you pain relief for at least two months.
In that case we would not proceed with the neurolytic celiac plexus block. We would discuss other possibilities of pain control with you.
You might have low blood pressure after the procedure. You will get intravenous fluids and be monitored in the recovery room until your blood pressure is back to normal. This will usually take between two and four hours. You might experience some diarrhea or softer stool. This will return to normal within a couple of days or a week.
You might need to continue taking some of your pain medications after the neurolytic celiac plexus block. If you were to take a lot of pain medications, or pain medication for a long period of time prior to the neurolytic celiac plexus block, it should not be stopped suddenly. We will discuss all this with you in detail before the procedure is done.