Much like an interregional highway system, our nervous system consists of countless branching nerve complexes. Wherever these nerves intersect the most, they become a nerve plexus. The human body has five spinal nerve plexuses, from which nerve roots along the spinal cord connect to numerous muscles and other body parts. In addition, the body has many different autonomic plexuses – the celiac nerve plexus is one such autonomic plexus and the largest autonomic nerve plexus.
While the list of functions and properties associated with the celiac nerve plexus is massive, one essential function that is particularly important in the context of pain management is pain signaling. Doctors can diagnose the root cause of certain types of visceral pain by targeting the celiac nerve plexus with specialized medication through a celiac nerve plexus block. This method can also be used as temporary and/or permanent treatment for intractable pain by blocking pain signals at their root, especially for pancreatic cancer.
What Is a Celiac Nerve Plexus Block?
The celiac nerve plexus exists roughly in the center of the abdomen and is known as the solar plexus. It innervates most of your vital organs throughout the abdomen through multiple smaller plexuses such as the hepatic (liver) plexus, the splenic (spleen) plexus, the gastric (stomach) plexus, the pancreatic plexus, the suprarenal (adrenal) plexus, the renal (kidney) plexus, the mesenteric plexus, and the testicular/ovarian plexus.
If you picture a human body from the front, the celiac plexus can be found roughly between the nipple line and the navel, behind a wall of abdominal muscle and the diaphragm. Anatomically, the celiac nerve plexus consists of various ganglia and nerves, interconnected as an irregularly shaped mass of nerve tissue stretching out between the visceral tissue of the organs, multiple vital blood vessels (such as the heart’s aorta), and the digestive tract.
Like any other mass of nerve tissue in the human body, precise techniques – such as anesthesia, neurolysis, and ablation – can temporarily or permanently shut down or damage the tissue and end pain reception. The procedure for doing so depends on the reason the celiac nerve plexus is targeted and the exact location of the pain.
In cases of pancreatic cancer-related pain, a neurolytic solution may be injected into the nerve tissue – such as alcohol – killing and destroying the nerves responsible for your intense abdominal pain. In cases where a temporary solution is required, an anesthetic or corticosteroid may be used instead.
When Is a Celiac Nerve Plexus Block Prescribed?
The most common reason to prescribe a celiac nerve plexus block to a patient is to reduce pain from pancreatitis or pancreatic cancer. A celiac nerve plexus block is usually only considered in cases of severe abdominal pain where other pain relief methods, including opioids, have failed. While they are the most common, pancreatic issues are not the only reason to prescribe a celiac nerve plexus block. Other conditions that may require a celiac nerve plexus block can include the following:
- Crohn’s disease;
- Gastrointestinal cancer;
- Cholangiocarcinoma;
- Chronic severe abdominal pain;
- Post-surgical severe abdominal pain;
- Pain related to the diaphragm, aorta, or adrenal glands;
- Any other severe, intractable abdominal pain (i.e., cannot be treated through medication alone).
Risks and Considerations
A celiac nerve plexus block can help patients with severe, intractable pain find temporary or permanent relief, depending on the method and injection agent used. Some drugs numb the targeted nerve tissue, while others damage the surrounding nerves to end pain signaling. All in all, the procedure is very low risk.
It is non-invasive and usually only requires two needles – one to apply a special dye to the area for computer imaging to pick up a better, higher contrast image of the surrounding soft tissue and a second needle to apply medication. However, there are still risks and considerations. Patients should reconsider or may not be eligible for celiac nerve plexus block-related treatment if they:
- Have blood clotting issues or rely on particular clotting medication they cannot stop using now;
- Have recently had or are currently experiencing an abdominal infection;
- Have some bowel obstruction;
- Are allergic to specific anesthetics or the available contrast dyes. Some people also experience heavy resistance to certain anesthetics, which they must disclose and discuss with their doctor.
In addition to these contraindications or considerations, there are a few potential risks:
- Gastroparesis, or delayed bowel movement;
- An allergic reaction to the steroid or anesthetic;
- An infection of the injection site;
- Minor internal or external bleeding after injection;
- Bruising around the injection site and potential swelling/itchiness/soreness;
- Diarrhea;
- Muscle spasms;
- Possible kidney or organ damage (very rarely);
- Numbness or paralysis (if the wrong nerve was targeted or a nerve was damaged during injection).
When a celiac nerve plexus block is performed, patients are usually required to relax and rest in a recovery area for at least one or two hours before being given the a-okay to go home. This rest period usually catches most potential complications, allowing doctors to correct and reduce the risk of ongoing problems quickly. If any other issues arise – such as sudden or severe pain or bleeding – always be sure to contact your doctor immediately and seek medical attention as soon as possible.
Preparing for the Celiac Nerve Plexus Block Procedure
A celiac nerve plexus block is not a major surgery or invasive procedure. Still, because of the interactions between the gastrointestinal area and the targeted nerve, it’s usually a good idea to avoid food or drink before your nerve block. This is especially important if you go under instead of staying awake. The use of anesthetics is safer on an empty stomach.
If you are on any medications, report all of them to your doctor. Certain medications, such as blood thinners, are dangerous to take before an injection of this sort. Suppose you smoke and/or drink regularly. In this case, your doctor will advise you to cut down in general but may specifically tell you to avoid both before and after your injection, as both alcohol and tobacco can lead to complications during the healing process and an increased risk of side effects.
Is a Celiac Nerve Plexus Block Right for You?
Celiac nerve plexus blocks are only prescribed in severe and untreatable abdominal pain cases. In these cases, the proper injection can become a godsend. But it’s essential to be well-informed – contact your doctor and discuss your options thoroughly before considering a nerve block, especially a neurolytic nerve block.
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