CT-Guided Celiac Plexus Block and Neurolysis for Chronic Upper Abdominal Pain

Abstract

Chronic visceral abdominal pain due to malignant and inflammatory conditions can be challenging to treat, requiring a multidisciplinary approach. Opiates are commonly employed in the palliation of chronic abdominal pain but are complicated by quality of life-limiting side effects such as nausea, vomiting, sedation, and constipation. Celiac plexus block and neurolysis (CPBN) are important tools in the multimodality approach to such pain, with documented improvement in pain scores and, importantly, reduction in opiate demands and improvement in quality of life. It targets the celiac relay station that mediates transmission of visceral nociceptive information from upper abdominal organs; distinguishing from somatic and neuropathic pain is important for clinical success. Key determinants of procedure success include patient selection, understanding relevant anatomy, how that anatomy is distorted by pathology, selection of location for block or neurolysis, as well as distribution and volume administered of injectate during the procedure. CPBN is a safe procedure associated with a low complication rate and may demonstrate better efficacy when used earlier in a patient's disease course.

Keywords

celiac plexus neurolysis - celiac plexus block - cancer pain management

Publication History

Received: 21 January 2022

Accepted: 04 May 2022

Article published online:
10 October 2022

• References

• 1 Kambadakone A, Thabet A, Gervais DA, Mueller PR, Arellano RS. CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. Radiographics 2011; 31 (06) 1599-1621
• 2 Cornman-Homonoff J, Holzwanger DJ, Lee KS, Madoff DC, Li D. Celiac plexus block and neurolysis in the management of chronic abdominal pain. Semin Intervent Radiol 2017; 34 (04) 376-386
• 3 Miguel R. Interventional treatment of cancer pain: the fourth step in the World Health Organization analgesic ladder?. Cancer Contr 2000; 7 (02) 149-156
• 4 Shulman M, Harris JE, Lubenow TR, Nath HA, Ivankovich AD. Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer. Clin J Pain 2000; 16 (04) 304-309
• 5 Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev 2011; 16 (03) CD007519
• 6 Jadad AR, Browman GP. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA 1995; 274 (23) 1870-1873
• 7 de Oliveira R, dos Reis MP, Prado WA. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain 2004; 110 (1-2): 400-408
• 8 Ischia S, Ischia A, Polati E, Finco G. Three posterior percutaneous celiac plexus block techniques. A prospective, randomized study in 61 patients with pancreatic cancer pain. Anesthesiology 1992; 76 (04) 534-540
• 9 Erdek MA, Halpert DE, González Fernández M, Cohen SP. Assessment of celiac plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain. Pain Med 2010; 11 (01) 92-100
• 10 Bhatnagar S, Khanna S, Roshni S. et al. Early ultrasound-guided neurolysis for pain management in gastrointestinal and pelvic malignancies: an observational study in a tertiary care center of urban India. Pain Pract 2012; 12 (01) 23-32
• 11 Wang PJ, Shang MY, Qian Z, Shao CW, Wang JH, Zhao XH. CT-guided percutaneous neurolytic celiac plexus block technique. Abdom Imaging 2006; 31 (06) 710-718
• 12 Haaga JR, Reich NE, Havrilla TR, Alfidi RJ. Interventional CT scanning. Radiol Clin North Am 1977; 15 (03) 449-456
• 13 Buy JN, Moss AA, Singler RC. CT guided celiac plexus and splanchnic nerve neurolysis. J Comput Assist Tomogr 1982; 6 (02) 315-319
• 14 Haaga JR, Kori SH, Eastwood DW, Borkowski GP. Improved technique for CT-guided celiac ganglia block. AJR Am J Roentgenol 1984; 142 (06) 1201-1204
• 15 Lee MJ, Mueller PR, vanSonnenberg E. et al. CT-guided celiac ganglion block with alcohol. AJR Am J Roentgenol 1993; 161 (03) 633-636
• 16 Montero Matamala A, Vidal Lopez F, Aguilar Sanchez JL, Donoso Bach L. Percutaneous anterior approach to the coeliac plexus using ultrasound. Br J Anaesth 1989; 62 (06) 637-640
• 17 Hol PK, Kvarstein G, Viken O, Smedby O, Tønnessen TI. MRI-guided celiac plexus block. J Magn Reson Imaging 2000; 12 (04) 562-564
• 18 Wang L, Lu M, Wu X. et al. Contrast-enhanced ultrasound-guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience. Eur Radiol 2020; 30 (08) 4514-4523
• 19 Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat 2010; 23 (05) 512-522
• 20 Mercadante S, Nicosia F. Celiac plexus block: a reappraisal. Reg Anesth Pain Med 1998; 23 (01) 37-48
• 21 Erdine S. Celiac ganglion block. Agri 2005; 17 (01) 14-22
• 22 Bonica JJ. The role of the anaesthetist in the management of intractable pain. Proc R Soc Med 1954; 47 (12) 1029-1032
• 23 Titton RL, Lucey BC, Gervais DA, Boland GW, Mueller PR. Celiac plexus block: a palliative tool underused by radiologists. AJR Am J Roentgenol 2002; 179 (03) 633-636
• 24 De Cicco M, Matovic M, Balestreri L, Fracasso A, Morassut S, Testa V. Single-needle celiac plexus block: Is needle tip position critical in patients with no regional anatomic distortions?. Anesthesiology 1997; 87 (06) 1301-1308
• 25 Rathmell JP, Gallant JM, Brown DL. Computed tomography and the anatomy of celiac plexus block. Reg Anesth Pain Med 2000; 25 (04) 411-416
• 26 Zhang XM, Zhao QH, Zeng NL. et al. The celiac ganglia: anatomic study using MRI in cadavers. AJR Am J Roentgenol 2006; 186 (06) 1520-1523
• 27 De Cicco M, Matovic M, Bortolussi R. et al. Celiac plexus block: injectate spread and pain relief in patients with regional anatomic distortions. Anesthesiology 2001; 94 (04) 561-565
• 28 Penman ID, Gilbert D. Basic technique for celiac plexus block/neurolysis. Gastrointest Endosc 2009; 69 (2, Suppl): S163-S165
• 29 Christo PJ, Mazloomdoost D. Cancer pain and analgesia. Ann N Y Acad Sci 2008; 1138: 278-298
• 30 Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet 1999; 353 (9168): 1959-1964
• 31 Noble M, Gress FG. Techniques and results of neurolysis for chronic pancreatitis and pancreatic cancer pain. Curr Gastroenterol Rep 2006; 8 (02) 99-103
• 32 Gress F, Schmitt C, Sherman S, Ikenberry S, Lehman G. A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain. Am J Gastroenterol 1999; 94 (04) 900-905
• 33 Kane NM, Korobkin M, Francis IR, Quint LE, Cascade PN. Percutaneous biopsy of left adrenal masses: prevalence of pancreatitis after anterior approach. AJR Am J Roentgenol 1991; 157 (04) 777-780
• 34 Sachdev AH, Gress FG. Celiac plexus bock and neurolysis: a review. Gastrointest Endosc Clin N Am 2018; 28 (04) 579-586
• 35 Puli SR, Reddy JB, Bechtold ML, Antillon MR, Brugge WR. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci 2009; 54 (11) 2330-2337
• 36 Barbon DA, Hsu R, Noga J, Lazzara B, Miller T, Stainken BF. Clinical response to celiac plexus block confirms the neurogenic etiology of median arcuate ligament syndrome. J Vasc Interv Radiol 2021; 32 (07) 1081-1087
• 37 Penman ID. Coeliac plexus neurolysis. Best Pract Res Clin Gastroenterol 2009; 23 (05) 761-766
• 38 Fugère F, Lewis G. Coeliac plexus block for chronic pain syndromes. Can J Anaesth 1993; 40 (10) 954-963
• 39 Plancarte R, de Leon-Casasola OA, El-Helaly M, Allende S, Lema MJ. Neurolytic superior hypogastric plexus block for chronic pelvic pain associated with cancer. Reg Anesth 1997; 22 (06) 562-568
• 40 Ferreira F, Pedro A. Ganglion impar neurolysis in the management of pelvic and perineal-cancer-related pain. Case Rep Oncol 2020; 13 (01) 29-34
• 41 Sindt JE, Brogan SE. Interventional treatments of cancer pain. Anesthesiol Clin 2016; 34 (02) 317-339
• 42 Zhao Y, Guo X, Wang K. et al. A retrospective multicenter study comparing bupivacaine and ropivacaine in endoscopic ultrasound guided celiac plexus neurolysis. Ann Palliat Med 2021; 10 (02) 1755-1762
• 43 Dolly A, Singh S, Prakash R, Bogra J, Malik A, Singh V. Comparative evaluation of different volumes of 70% alcohol in celiac plexus block for upper abdominal malignancies. South Asian J Cancer 2016; 5 (04) 204-209
• 44 Bahn BM, Erdek MA. Celiac plexus block and neurolysis for pancreatic cancer. Curr Pain Headache Rep 2013; 17 (02) 310
• 45 Koyyalagunta D, Engle MP, Yu J, Feng L, Novy DM. The effectiveness of alcohol versus phenol based splanchnic nerve neurolysis for the treatment of intra-abdominal cancer pain. Pain Physician 2016; 19 (04) 281-292
• 46 Ischia S, Luzzani A, Ischia A, Faggion S. A new approach to the neurolytic block of the coeliac plexus: the transaortic technique. Pain 1983; 16 (04) 333-341
• 47 Lieberman RP, Waldman SD. Celiac plexus neurolysis with the modified transaortic approach. Radiology 1990; 175 (01) 274-276
• 48 Wendling H. Ausschaltung der Nervi splanchnici durch Leitungsanesthesie bei Magenoperationen und anderen Eingriffen in der oberen Bauchule. Beitr Klin Chir 1918; 110: 517
• 49 Wiersema MJ, Wiersema LM. Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc 1996; 44 (06) 656-662
• 50 Matamala AM, Lopez FV, Martinez LI. The percutaneous anterior approach to the celiac plexus using CT guidance. Pain 1988; 34 (03) 285-288
• 51 Romanelli DF, Beckmann CF, Heiss FW. Celiac plexus block: efficacy and safety of the anterior approach. AJR Am J Roentgenol 1993; 160 (03) 497-500
• 52 Ina H, Kitoh T, Kobayashi M, Imai S, Ofusa Y, Goto H. New technique for the neurolytic celiac plexus block: the transintervertebral disc approach. Anesthesiology 1996; 85 (01) 212-217
• 53 Kamdar MM, Edwards DA, Thabet AM, Volney SJ, Rathmell JP. A novel modified retrocrural approach for celiac plexus block: the single-needle retroaortic technique. Reg Anesth Pain Med 2015; 40 (05) 610-615
• 54 Davies DD. Incidence of major complications of neurolytic coeliac plexus block. J R Soc Med 1993; 86 (05) 264-266
• 55 Arellano RS, Garcia RG, Gervais DA, Mueller PR. Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol 2009; 193 (06) 1686-1690
• 56 Arellano RS, Gervais DA, Mueller PR. CT-guided drainage of abdominal abscesses: hydrodissection to create access routes for percutaneous drainage. AJR Am J Roentgenol 2011; 196 (01) 189-191
• 57 Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg 1995; 80 (02) 290-295
• 58 Cataldo R, Potash M. Atropine as a treatment of diarrhea after celiac plexus block. Anesth Analg 1996; 83 (05) 1131-1132
• 59 Gafanovich I, Shir Y, Tsvang E, Ben-Chetrit E. Chronic diarrhea–induced by celiac plexus block?. J Clin Gastroenterol 1998; 26 (04) 300-302
• 60 Moore DC. Computed tomography eliminates paraplegia and/or death from neurolytic celiac plexus block. Reg Anesth Pain Med 1999; 24 (05) 483-486
• 61 Moore DC. The dreaded complications from neurolytic celiac plexus blocks are preventable!. Reg Anesth Pain Med 2004; 29 (04) 377-378
• 62 Minaga K, Kitano M, Imai H, Miyata T, Kudo M. Acute spinal cord infarction after EUS-guided celiac plexus neurolysis. Gastrointest Endosc 2016; 83 (05) 1039-1040 , discussion 1040
• 63 Fujii L, Clain JE, Morris JM, Levy MJ. Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis. Endoscopy 2012; 44 (Suppl 2 UCTN): E265-E266
• 64 Oguz G, Senel G, Kocak N. Transient paraplegia after neurolytic splanchnic block in a patient with metastatic colon carcinoma. Korean J Pain 2018; 31 (01) 50-53
• 65 Wong GY, Brown DL. Transient paraplegia following alcohol celiac plexus block. Reg Anesth 1995; 20 (04) 352-355
• 66 Burton AW. Celiac plexus blocks: wider application warranted for treating pancreatic cancer pain. J Support Oncol 2009; 7 (03) 88-89
• 67 Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol 2007; 102 (02) 430-438
• 68 Mercadante S. Celiac plexus block versus analgesics in pancreatic cancer pain. Pain 1993; 52 (02) 187-192
• 69 Kawamata M, Ishitani K, Ishikawa K. et al. Comparison between celiac plexus block and morphine treatment on quality of life in patients with pancreatic cancer pain. Pain 1996; 64 (03) 597-602
• 70 Wong GY, Schroeder DR, Carns PE. et al. Effect of neurolytic celiac plexus block on pain relief, quality of life, and survival in patients with unresectable pancreatic cancer: a randomized controlled trial. JAMA 2004; 291 (09) 1092-1099
• 71 Zhang CL, Zhang TJ, Guo YN. et al. Effect of neurolytic celiac plexus block guided by computerized tomography on pancreatic cancer pain. Dig Dis Sci 2008; 53 (03) 856-860
• 72 Staats PS, Hekmat H, Sauter P, Lillemoe K. The effects of alcohol celiac plexus block, pain, and mood on longevity in patients with unresectable pancreatic cancer: a double-blind, randomized, placebo-controlled study. Pain Med 2001; 2 (01) 28-34
• 73 McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, Cohen SP. The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract 2013; 13 (02) 89-95
• 74 Gress F, Schmitt C, Sherman S, Ciaccia D, Ikenberry S, Lehman G. Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol 2001; 96 (02) 409-416
• 75 Fusaroli P, Caletti G. Is there a role for celiac plexus block for chronic pancreatitis?. Endosc Int Open 2015; 3 (01) E60-E62