Celiac Plexus Block What you need to know Rainier E. Guiang, M.D. Fellow, Pain Management History • First documented in 1914 by Kappis • Used primarily for surgical anesthesia • Spinal Anesthesia replaced its need • Used as diagnostic tool to differentiate somatic and visceral pain • 1957 – first neurolytic Anatomy • Preganglionic – Greater splanchnic nerve (T5-10) – Lesser splanchnic nerve (T10-11) – Least splanchnic nerve (T11-12) • Up to 5 ganglia • Most commonly at level of L1 • Plexus lies anterior and lateral to aorta & below celiac artery Anatomy – sympathetic trunk Innervation • Pancreas • Liver • Gallbladder • Omentum • Mesentery • Alimentary tract – stomach to tranverse colon • Increases peristalsis Indications • Pain – Flank – Retroperitoneal – Upper abdominal • ?sympathetically mediated? • Pancreatitis (acute or chronic) • Precursor to neurolysis Contraindications • Anticoagulated patients • Impaired liver function • Local / systemic infections / sepsis • Bowel obstruction Pre-op preparation • Coagulation studies • IV fluids Technique • Prone Position • Identify L1 • Go to Scotty Dog view • Aim for anterolateral aspect of L1 on the R On the left, ganglia is just anterior to the aorta Oblique View Lateral View AP View Side Effects / Complications • Infection • Hematoma / intra-abdominal bleed • Intravascular injection / paraplegia • Epidural, subdural, subarachnoid • Nerve root injury • Pneumothorax • Bowel Perforation • chylothorax What is always asked on the ABA Boards? • Name the two most common side effects of a celiac plexus block – Diarrhea – Hypotension • What level is the ganglia located at? – L1 These will be on the exam! References • Waldman, SD. Atlas of Interventional Pain Management, 2nd edition 2004 • Raj, PP. Radiographic Imaging for Regional Anesthesia and Pain Management, 2003.