Celiac Plexus Blockade

The celiac sympathetic ganglia are located on both sides of the celiac artery anterior to the aorta and anterior to the cura of the diaphragms (Figure 12.3A). Celiac sympathetic nerves receive and send out impulses to upper abdominal viscera, including the pancreas, spleen, liver, gallbladder, mesentery, transverse colon, and stomach.

Indications

Indications for celiac plexus blockade include the following:

Intractable pain from terminal pancreatic cancer Intractable pain from chronic pancreatitis

Intractable pain from other sources of the upper abdomen including visceral arterial insufficiency

Technique

Celiac plexus blockade should always be performed with image guidance; typically CT is used.2,3,5 However, some operators prefer ultrasound for needle guidance while others have employed fluoroscopic guidance. For CT guidance, one starts at approximately the T12 level to locate the celiac artery. Caudal-to-cranial tube angulation may be quite helpful to keep the needle out of the posterior inferior lung. Needles should be directed from posterior to anterior such that the tips pass very close to the adjacent T12 vertebral body and terminate on ei-

greater splanchnic nerve lesser splanchnic nerve diaphragm

12tli sympathetic ganglion celiac ganglion and artery greater splanchnic nerve lesser splanchnic nerve diaphragm aortic renal ganglion--

Splanchnic Nerve Human

Figure 12.3. (A) The sympathetic chain and distribution in the lower thoracic, upper abdominal region. (B) Cross-sectional drawing at the level of T12, depicting bilateral needle placement for a celiac block via a pos-terolateral approach. The needle tip should be anterior to the aorta and diaphragmatic crura and at or above the celiac artery origin.

Figure 12.3. (A) The sympathetic chain and distribution in the lower thoracic, upper abdominal region. (B) Cross-sectional drawing at the level of T12, depicting bilateral needle placement for a celiac block via a pos-terolateral approach. The needle tip should be anterior to the aorta and diaphragmatic crura and at or above the celiac artery origin.

aortic renal ganglion--

supe'ior mesenteric artery and ganglion acrtic plexus inferior mesenteric artery, ganglion and plexus celiac ganglia stomach.

spleen celiac trunk abdominal aorta interior vena cava celiac ganglia stomach.

spleen

Celiac Plexus Block

12th rib

12th thoracic vertebra liver left kidney

12th rib a

Vertebrae And Rib TumorPlexusblockade

Figure 12.3. Continued. (C) Celiac plexus blockade in a prone patient. Under CT guidance, the needles enter posterior to anterior, obliquely. The needle tips should lie on each side of the celiac artery (approximately T12 level). (D) Celiac plexus blockade in supine patient. Under CT guidance, the needle passes through the left lobe of the liver. The needle tip should be positioned immediately anterior to the celiac artery.

Figure 12.3. Continued. (C) Celiac plexus blockade in a prone patient. Under CT guidance, the needles enter posterior to anterior, obliquely. The needle tips should lie on each side of the celiac artery (approximately T12 level). (D) Celiac plexus blockade in supine patient. Under CT guidance, the needle passes through the left lobe of the liver. The needle tip should be positioned immediately anterior to the celiac artery.

ther side of the aorta while passing through the cura of the diaphragms (Figure 12.3B). In some situations, it may be necessary to pass the needle through the aorta. (A 22- or 25-gauge needle should not pose a problem as long as the patient is not coagulopathic, Figure 12.3C.)

An alternative to a posterior-to-anterior approach is an anterior-to-posterior approach through the left lobe of the liver (Figure 12.3D). This can be done by ultrasound or CT guidance. The needle tip should lie just anterior to the celiac artery. Often an anterior approach requires only a single needle for adequate distribution of medication along both sides of the celiac plexus. Once the needle tip has reached the target, confirmation is achieved by injecting 3 to 4 mL of iodine contrast medium (Omnipaque 240 or equivalent) to confirm that the needle tips are anterior to the cura of the diaphragms and are not in a vascular structure.

For therapy, 10 to 20 mL of 0.25% bupivacaine can be injected for temporary relief. For permanent relief, 5 to 10 mL of absolute alcohol (or 6% phenol) can be administered for a neurolysis (under general anesthesia).

Following celiac plexus blockade, it is important to hydrate the patient generously with intravenous fluids for 24 hours since vascular pooling of blood in the visceral circulation due to splanchnic vasodi-lation may render the patient quite hypotensive.

Contraindications to celiac plexus blockades include uncorrected co-agulopathy, bowel obstruction, and allergy to any of the medications that might be used. Celiac plexus blockades should be avoided when there is an underlying bowel obstruction, since unopposed parasym-pathetic activity might lead to increased bowel motility.

A common complication to celiac plexus block is backache. Vascular damage or embolization can occur with intravascular injections.

Was this article helpful?

0 0
Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Responses

  • Felix Koenig
    What is the celiac plexus of the body?
    8 years ago
  • liberata
    What vertebral level is the celiac plexus at?
    7 years ago
  • saba
    What can be done with a tumor on celiac artery?
    7 years ago

Post a comment