Celiac Plexus Block
There is a lot of misinformation about the celiac plexus block out there and this page is supposed to help with that. This page is based on medical journals, research and studies.
What is the Celiac Plexus?
The celiac plexus is a bundle of nerves connected to the Celiac Ganglia. This nerve cluster serves the liver, pancreas, gallbladder, stomach, spleen, kidneys, and intestines.
What is a Celiac Plexus Block (CPB)?
The nerve block is an injection of medication put directly into the Celiac Plexus. The cocktail usually includes numbing medication, steroids, and an anti-inflammatory. Every doctor has their own cocktail that they use so your block will differ depending on whom you see.
What does the Celiac Plexus Block do?
The goal of the procedure is to block your nerves from sending pain signals to a part of your abdomen. This block is purely to remove pain. It isn’t designed to get rid of nausea, vomiting, diarrhea, or constipation. Some people have found their other GI symptoms do decrease or go away after having the block but that isn’t what the block is designed to do.
How is the Celiac Plexus Block procedure done?
There are two common ways to do a celiac plexus block; one is from the back (percutaneous). The other is endoscopically.
What is done during a Celiac Plexus Block Percutaneous?
This procedure is typically performed face down on a table. Your Provider will guide a needle through your back and into celiac plexus nerves and inject an anesthetic to numb your nerves. The procedure may take 15 - 30 minutes, although it is typically completed in just a few minutes.
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Steps for procedure:
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The patient comes in and lays down face down
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Nurse Sterilizes the back
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Medication is given via IV to sedate the patient
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Local Anesthesia is applied
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Passing a needle through the back to the celiac area
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Injection of medication into celiac plexus
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Flush with saline
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Retracting the needle
What is done during a Celiac Plexus Block Endoscopically?
This procedure uses a scope that goes down your throat and uses an ultrasound probe to guide them into your plexus to inject the medication. This procedure typically takes 15 - 20 minutes.
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Steps for procedure:
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The patient receives an IV and goes under sedation
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Locating the aorta and tracing it to the celiac trunk
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Passing a needle through the scope into the celiac area
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Injecting medication
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Flushing the needle with saline
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Retracting the needle and removing the scope
Are there different types of medications used for Celiac Plexus Block?
Yes, different types of medications can be used for CPBs. These can affect how long your blocks last and how the block itself works. If you have any reactions to the following medications, you should bring them up with your provider. In most cases, alternatives can be used.​
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Medication Types:
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Local anesthetics: Such as ropivacaine or bupivacaine
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Corticosteroids: Such as dexamethasone or methylprednisolone
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Adjuncts: Such as clonidine or epinephrine
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Neurolytic: Such as phenol or ethanol
What’s the difference between a Celiac Plexus Block and a Neurolytic Celiac Plexus Block?
The most significant difference between the standard CPB and Neurolytic CPB is the time they last. Many find that the standard block doesn’t last as long as they need it to. So, they get a block with a neurolytic agent.
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Celiac Plexus Block
CPBs can last from a few hours to a few months. This range depends on the type of medication used and how the patient's body processes the medication.
Neurolytic Plexus Block
Neurolytic CPBs are considered a longer-term pain relief version of the CPB. They usually last anywhere from 6 months to a year. This range depends on the type of medication used and how the patient's body metabolism processes the medication.
Can a Celiac Plexus Block be done without sedation?
A Percutaneous CPB can be done without sedation. However, some doctors still provide a local numbing agent before the procedure. If this is your first experience with nerve blocks, it isn’t recommended to do it this way.
How will I feel after the block?
If you have had a positive response to the block, you should feel some relief from your MALS pain. It varies from person to person for how long this will last. You have to keep in mind that this is supposed to be temporary. It's treating the symptoms of MALS; it's not going to fix it.
Are there negative side effects to a block?
Yes, just like any other medication, there is a risk of negative side effects. The most common responses are diarrhea and a decrease in blood pressure. So, if you have low blood pressure, normally, that is something to discuss with your doctor before undergoing the procedure.​
​Side Effects Include:
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Bruising, swelling, or soreness at the injection site
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Infection at the treatment site
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Diarrhea
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Low blood pressure
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Muscle spasms
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Rare Side Effects:​
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Allergic reaction to anesthesia or the contrast dye
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Decreased blood flow to your spinal cord
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Delayed emptying of stomach contents
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Kidney damage or other organ damage
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Nerve damage
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Paralysis due to a spinal cord injury
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Seizures
If you experience any of the following symptoms, you should call the doctor who performed your block.
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Dizziness
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Fainting
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Unusual Thirst (Dehydration)
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Shortness of Breath.
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Signs of Infection (Fever, Oozing, and Redness at the Treatment Site)
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Tingling, Numbness, or Loss of Feeling in your Legs.
How long does the average Celiac Plexus Block Last?
The average CPB lasts from a few weeks to several months, depending on the medications used and the patient's metabolism.
Can I have no response or a negative response to the Celiac Plexus Block and still have MALS?
Yes, just like any other medication, there are times when a CPB does not work for a MALS patient. This can be due to a variety of factors. It is often more related to how the patient metabolizes nerve medication. Celiac Plexus Blocks are reported to be 70 - 85% effective for general GI Pain.
Are there other options for Nerve Blocks?
Absolutely, if you find that a CPB didn’t work for you or gave you too many side effects there are other blocks to try. The most popular being a Splanchic Nerve Block (SNB) or a Hypogastric Nerve Block (HGNB). Make sure to discuss all your options with your pain management team so you can find what works best for you.