腹腔神経叢ブロックに関するよくある質問
腹腔神経叢ブロックについては多くの誤った情報があり、このページはその助けになるはずです.このページは、医学雑誌、研究、研究に基づいています。
腹腔神経叢とは何ですか?
腹腔神経叢は、腹腔神経節に接続された神経の束です。この神経クラスターは、肝臓、膵臓、胆嚢、胃、脾臓、腎臓、および腸に役立ちます.
腹腔神経叢ブロック (セリアック神経ブロック) とは?
神経ブロックは、腹腔神経叢に直接薬を注射する方法です。カクテルには通常、麻痺薬、ステロイド、抗炎症剤が含まれています。すべての医師は独自のカクテルを使用しているため、ブロックは誰に会うかによって異なります。
腹腔神経叢ブロックは何をしますか?
この処置の目的は、神経が腹部の一部に痛みの信号を送るのを遮断することです。このブロックは純粋に痛みを取り除くためのものです。吐き気、嘔吐、下痢、便秘を解消するようには設計されていません。一部の人々は、ブロック後に他の消化管症状が軽減または消失することを発見しましたが、それはブロックが行うように設計されているものではありません.
腹腔神経叢ブロックの手順はどのように行われますか?
腹腔神経叢ブロックには 2 つの方法があります。 1 つは、最も一般的な方法である後ろからです。もう 1 つは、スコープを喉まで下げ、超音波プローブを使用して神経叢に誘導し、薬を注入する方法です。
背中からの腹腔神経叢ブロック中に何が起こりますか?
平均して、リラックスするのに役立つ薬が与えられ、トワイライトセデーションを受けます。 Twilight sedation はイベント自体を忘れさせますが、これは鎮静中に起こることです。痛みの専門家が背中の皮膚を麻痺させます。次に、X 線画像を使用して、背骨の両側の背中に細い針を挿入します。彼らは染料を注入して、あなたを腹腔神経叢に直接突き刺します.神経叢が見つかったら、鎮痛剤を注射して、神経が痛みの信号を腹部に伝えるのをブロックします。施術後、背中が痛くなることがあります。
What is done during a Celiac Plexus Block Percutaneous (through the back)?
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 normally takes 15 - 20 minutes.
Steps for procedure:
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Patient receives 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 CPBs?
Yes, there are different types of medications that can be used for CPBs. These can effect how long your blocks last as well as impact how the block itself works. If you have any reactions to the following medications you should bring that up with your provider. There are alternatives that can be used in most cases.
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 blocks: Such as phenol or ethanol
What’s the difference between a celiac plexus block and a neurolytic celiac plexus block (neurolysis)?
The biggest difference between the standard CPB and Neurolytic CPB is the length of 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.
Celiac Plexus Block
CPBs can have a range of a few hours to a few months. This range depends on what type of medication is used and how the patients body metabolism processes the medication.
Neurolytic Plexus Block
Neurolytic CPBs are considered a longer term pain relief version of the CPB. They last normally anywhere from 6 months to a year. This range depends on the type of medication used and how the patients body metabolism process the mediation.
A Neurolytic Plexus Block is done with using ethanol and phenol. Ethanol is usually used in a concentration of 50% as concentrations higher than 50% can cause irreversible damage to the nerves. Phenol is often used at a concentration of more than 5% in saline as it can cause necrosis if the percentage is too high. Phenol has been found to be less irritating and more tolerable than ethanol in some patients.
Can a Celiac Plexus Block be done without sedation?
A Percutaneous CPB can be done without sedation. Some doctors still provide a local numbing agent before the procedure. If this is your first ever 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 having negative side effects. The most common response is 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.
How long does the average Celiac Plexus Block Last?
The average CPB lasts anywhere from a few weeks to several months. This depends on what types of medications are used and how a patient metabolizes the medication.
Can I have no response or a negative response to the Celiac Plexus Block and still have MALS?
Yes, just like any other medication out there there are times when a CPB does not work for a MALS patient. This can be due to a variety of factors.
Can a Celiac Plexus Block tell you how you will feel after surgery?
No, even if you have a positive response to a CPB it can’t tell you a 100% how you will feel after surgery. Unfortunately there are times when someone responds well to a CPB but doesn’t find the same relief from surgery. It can also happen that someone has no reaction to a CPB but has full symptom relief from the surgery.
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.