Plexus Coeliacus Permanent Block

What is a coeliac plexus permanent block?

A plexus is a network of nerves. One such plexus is the coeliac plexus which is located towards the back of the upper abdomen. This network of nerves is important for pain and can relieve pain when blocked, for example in people suffering from pain in cancer of the upper abdominal organs such as the pancreas. The coeliac plexus is located to the front of the vertebral column and can easily be reached with a needle. A block of the coeliac plexus is achieved by applying electrical current to the nerve bundles via a needle so that they heat up. This stops the coeliac plexus from passing on any more pain signals. Alcohol is also sometimes used to block the coeliac plexus. The X-ray below (Figure 1) shows an example of a coeliac plexus block near the vertebral column. The black lines are the needles (number 1 in Figure 1) whose tips have been inserted to the front of a vertebra (number 2 in Figure 1).

 

coeliacus

Figure 1. X-ray of a coeliac plexus block (see text)

 

What should I be aware of before undergoing coeliac plexus permanent block?

Any of the following situations should be reported to your pain specialist if he proposes a permanent coeliac plexus block:

  • If you are pregnant: since X-ray equipment is used, pregnant women may not undergo a permanent coeliac sympathetic block and a new appointment has to be made.
  • If you are ill or have a fever on the day of treatment you cannot undergo a permanent coeliac sympathetic block, in which case a new appointment will have to be made.
  • If you are allergic to iodine, bandages, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
  • If you are taking blood thinners, you should notify your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.

How should I prepare for a coeliac plexus permanent block?

  • No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
  • You may eat before treatment and take your normal medication.
  • N.B.: this does not include blood thinners, as mentioned above.
  • Make sure you have someone to take you home, because you may not drive for 24 hours.

In serious cases your pain specialist will decide for hospitalisation and you are ask to bring your nightwear.

How does a coeliac plexus block work?

  • The treatment will be performed in the surgical day-care centre, where you will be asked to change into a surgical gown. This gown closes at the back.
  • A nurse will escort you to the treatment room, where there is a treatment table, an X-ray machine and television monitors.
  • You will be positioned on the treatment table with your stomach on top of a cushion.
  • The blood pressure and the amount of oxygen in your blood will be controlled during the treatment.
  • A drip will be placed in your hand.
  • The right place of the block is estimated with aid of fluoroscopy.
  • This place is marked on the skin with a felt pen.
  • The area around this site is then disinfected with a cold, red liquid.
  • The pain specialist covers the area with sterile drapes.
  • After a local anesthetic has been applied to the skin, the pain specialist, by means of fluoroscopy (via the television monitor), will insert the needles in the correct place.
  • Some contrast fluid is also injected to enable the position of the needle to be clearly visible.
  • If the needle is in the right place the permanent coeliac plexus block is performed.
  • In a permanent coeliac plexus block, besides local anaesthetics are injected around the nerves of coeliac plexus, small amount of alcohol or phenol are administrated to block the nerves.
  • After this treatment you need to make an appointment at the pain clinic after six to eight weeks with your own pain specialist. The effect of treatment will be checked and further policy will discuss with you.

What are dangers and side effects of a coeliac plexus block?

After a permanent coeliac plexus block, the following complications or side effects can occur:

  • In very rare cases paraplegia can occur with complete or partial paralysis of both legs.
  • Diarrhoea is a frequent side effect.
  • Sometimes the blood pressure can become low that is easy to treat.
  • The first week after the treatment you can feel a little bit dizzy when suddenly stand up.

When can I expect pain relief after the treatment?

  • Due to a permanent coeliac plexus block afterpains can occur, which may last a week and will disappear.
  • The optimum results of treatment are seen after one day.
  • An appointment with your pain specialist will be planned.