Celiac Plexus Block What you need to know

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					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.

				
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posted:4/24/2008
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