47 Celiac Plexus Block

Perspective

Celiac plexus block can be used for many types of intra-abdominal visceral pain syndromes. Its most frequent application is to relieve pain associated with intra-abdominal cancer, using a neurolytic solution. Visceral analgesia can also be provided for patients undergoing upper abdominal surgery; combining celiac plexus block with intercostal nerve block provides an unrivaled quality of immediate postoperative analgesia.

Patient Selection

Most celiac plexus blocks are carried out for cancer pain therapy, and the majority of blocks used for cancer pain are related to gastric or pancreatic malignancies. The celiac plexus provides innervation to most of the gut from the lower esophagus to the level of the splenic flexure of the colon. Therefore, celiac plexus block may be applicable to a wide variety of patients with intra-abdominal malignancy.

Pharmacologic Choice

The celiac plexus is primarily a sympathetic ganglion; thus, low concentrations of local anesthetics are successful in blocking the celiac plexus. For example, 0.5% lidocaine, 0.125% or 0.25% bupivacaine, or 0.1% or 0.2% ropivacaine is adequate. If celiac plexus neurolysis is sought, my choice is 50% alcohol, which is formulated by combining equal volumes of 100% alcohol with 0.25% bupivacaine or 0.2% ropivacaine, to a total of 50 mL.

Placement

The celiac plexus has also been called the solar plexus, the celiac ganglion, and the splanchnic plexus (Fig. 47-1). It is the largest of the three great plexuses of the sympathetic nervous system in the chest and abdomen: the cardiac plexus innervates the thoracic structures, the celiac plexus innervates the abdominal organs, and the hypogastric plexus supplies the pelvic organs. All three of these plexuses contain visceral afferent and efferent fibers. In addition, they contain some parasympathetic fibers that pass through after originating in cranial or sacral areas of the parasympathetic nervous system.