Whether it is pancreatitis, gallstones, Crohn’s, gastric cancer, or gastritis, massive chronic abdominal pain can be debilitating and can vastly reduce quality of life. While acute abdominal pain passes and resolves itself after treatment or over the course of hours to days, chronic pain has a staying power ranging anywhere from several weeks to a few years, appearing intermittently. While there are a wide range of different causes for chronic abdominal pain, not all of them can be quickly or effectively addressed. Certain cancers and forms of inflammation take time to treat and heal, leaving a patient in an unbearable state.
Medication can help with the pain but is not always a good option. From side effects to allergic reactions or the potential of addiction, strong pain killers like opioids do not always help address pain that lasts weeks and months. It is in these cases that other options for pain management must be explored, opening up a world of invasive interventions aimed at helping patients avoid powerful episodes of intense pain.
Among these interventions is a celiac plexus block procedure, which targets a complex bundle of nerves tied to various organs and muscles in the abdomen, blocking pain signals that travel from the celiac plexus to the brain. If used appropriately, this procedure can greatly reduce abdominal pain for a considerable period, allowing for other treatments to address the cause of the pain, or effectively helping someone live with their pain in the long-term.
What Are Celiac Plexus Blocks?
Also known as the ‘solar plexus’ due to its central location within the torso, the celiac plexus is a complex bundle of nerves found deep within the abdomen, behind intersecting walls of abdominal muscle.
Functioning roughly as a relay for signals from the brain to various organs throughout the body and vice versa, the celiac plexus can be targeted with medication to effectively block out pain signals. The celiac plexus block has been employed for decades as a way to reliably shut down pain signals traveling from the torso to the brain, usually as part of an invasive surgery, as part of surgical anesthesia.
A celiac plexus block is typically considered when other less invasive, less aggressive painkilling interventions have proved less than fruitful. If patients experience unbearable abdominal pain and do not respond effectively to medication, the celiac plexus block may provide them with significant relief. The block targets the organs connected to the plexus, particularly the:
- Omentum (visceral tissue covering the liver, intestines, and stomach)
- GI (digestive tract)
Preparing for Your Celiac Plexus Block Procedure
Speak to your doctor to check on your current medications and determine which you should stop taking prior to the procedure. You may be asked to take some pain medication on the morning of the procedure with minimal water. Don’t eat the night before the procedure and limit your fluid intake as per doctor’s orders.
Depending on what imaging tools are used, it’s important to remove all metallic objects on your person, including a watch, jewelry, belt, piercings, and so on. Bring glasses instead of contacts. Your doctor will inform you of everything you should and shouldn’t bring to the clinic or hospital. If you wear makeup, refrain from using any eye makeup or creams, and apply only light moisturizers.
How Is the Procedure Performed?
Before beginning the procedure, a patient is optionally given a relaxant to help them remain calm. Because the procedure is quick and usually involves a patient who is awake, remaining calm is important.
Once the patient is relaxed, an x-ray is used to determine exactly where the celiac plexus is, establishing a target for the subsequent injection. Lying on their stomach, a patient is first treated with a local anesthetic, and then a thin needle is passed through the tissue in the back, injecting another anesthetic. A second needle is used, using the x-ray as a guide, to inject a dye into the body to double-check that the correct area is being targeted. Once the dye confirms that the second needle is in the right spot, medication is used to numb the nerves in the area.
The medication used depends on the intended function of the block, in relation to the origin of the abdominal pain. Many injections use a corticosteroid or epinephrine to numb the nerves, bringing lasting yet temporary relief. Sometimes, a neurolytic agent is used, such as alcohol, to destroy the nerves. This procedure may be controversial and is used to help patients with an unbearably painful terminal abdominal cancer (such as pancreatic cancer). This is usually reserved for intractable pain.
Once the block is applied, the patient is asked to continue laying still for a while, before sitting up and reviewing their pain. If relief was achieved, the patient is brought to a recovery room to lie in rest. If no complications occur, the IV is discontinued and the patient is discharged.
Complications and Problems
Like other procedures, a celiac plexus block involves a certain amount of risk. In most cases, side effects are scarce and only involve pain and tenderness around the injection site. It’s unlikely for a celiac plexus block to develop into a different condition. However, in rare cases, the block may cause:
- Bloody urine
- Blood pressure problems
- Collapsed lung
Some of these complications are the result of improperly injecting the medication into the body, while others – such as an infection – are highly unlikely in most patients, unless their immune system is compromised due to a pre-existing condition or a conflicting treatment (such as chemotherapy).
Celiac Plexus Blocks and Medication
A doctor will go over your medical history and ensure that you are ready for the procedure by appropriately reducing your intake of certain medications if they present contraindications. Medications that may complicate a nerve block include anticoagulants (blood thinners), diuretics, and diabetes medication (insulin or other forms of medication).
NSAIDs and aspirin can also negatively affect clotting and speed up bleeding. Your doctor will present you with a list of medications you shouldn’t take prior to the procedure and will advise you on how and when to wean off your medication to avoid other potential complications. Be sure to discuss your medical history with your doctor before a celiac plexus block procedure, and do not stop taking your current medication without precise instructions.
After Your Procedure
A celiac plexus block procedure doesn’t require an overnight stay for recovery, but the anesthesia used throughout the procedure may make you feel nauseous or dizzy once fully processed. It is wise to arrange for someone to pick you up and drive you home to rest. After the procedure, the most important thing is to closely monitor your condition. It’s normal to feel sore for a few days and have diarrhea. Refrain from driving, lifting, or operating machinery for at least a day after the procedure. No alcohol either, although you may resume taking pain medication.
The block takes a few days to fully go into effect. Your pain may spike for the first 2 days after the procedure, although it’s important to call and notify your doctor if your pain continues to grow past 48 hours. Call your doctor if your temperature spikes, if your injection site is swelling, or if other unsettling symptoms present themselves.