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Coeliac plexus block

If you are considering having a coeliac plexus block or have a procedure planned, it is important to know all you can about it. This includes:

 

  • why you need this procedure

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have pain in your pancreas, liver, or rarely, your upper intestines. The pain involves the sympathetic nerves in this area. The sympathetic nerves control the things that we do not need to think about, such as digestion, blood pressure and heart rate. This group of nerves do not normally send pain messages, but they become ‘switched-on’ in certain conditions. We do not know why this happens, but have learnt to recognise the times when it does.

Coeliac plexus block 2

Pain from the sympathetic nerves does not respond to the usual painkillers that we may use for simple pain, like a headache. Neither does it respond well to stronger painkillers, such as those used for a broken bone. Sympathetic pain seems to be present all the time, sometimes getting worse and sometimes easing off. The pain may be affected by heat or cold and may therefore change with the weather. When the pain is in the tummy it may be related to eating and digestion.

 

The pain from the coeliac plexus is a pain that is present in the upper abdomen, under the ribs. It often feels as if it passes straight through to the back. The pain can be described as being sharp, stabbing or shooting. Unfortunately, there is no exact test to confirm the diagnosis. The doctor must recognise a pattern in the description of the pain.

 

Injecting local anaesthetic, around the sympathetic nerves in the coeliac plexus, should reduce your pain.

 

What is the coeliac plexus?

A ‘plexus’ is a bundle of nerves that come together, sending out many branches and communications. In this case, the sympathetic nerves go to the pancreas, liver and upper intestines all come together around a large blood vessel. This blood vessel is called the coeliac artery; hence the name coeliac plexus.

 

The coeliac plexus is close to the spine at the level of your umbilicus, which is commonly known as the tummy button.

Coeliac plexus block 2

What is a coeliac plexus block?

A coeliac plexus block is an injection of local anaesthetic around the coeliac plexus. Pain from the upper part of the abdomen can send pain messages through this point. The organs involved are usually the pancreas, liver, or rarely, the upper intestines.

Coeliac plexus block 3

By injecting local anaesthetic and sometimes anti-inflammatory steroids around this place, the pain messages can be blocked and the pain reduced. The injection is given from the back.

 

If required, only a small amount of steroid is needed. It will not cause any of the side effects sometimes associated with taking steroid tablets. They are not the same kind of steroids that athletes may take.

 

What has gone wrong?

The sympathetic nerves have started sending pain messages. It is not at all clear why this happens. It is known that by blocking the activity of the sympathetic nerves the pain can be reduced.

 

The aims

The aim of the procedure is to reduce the signals sent by the sympathetic nerves and hence reduce the pain. 

 

The benefits

Your pain should be reduced, so you should be able to move around more easily. If successful, the block can avoid the need for tablet medications, or at least reduce the number of tablets you need to take.

 

Are there any alternatives?

By the time you have the coeliac plexus block you should have already tried other more simple treatments. These include rest, painkilling and anti-inflammatory tablets, and perhaps very strong painkillers, such as morphine.

 

What if you do nothing?

If you do nothing there are several things that may happen:

 

  • With time and rest the pain may settle on its own

  • The pain and difficulty in performing daily activities may remain the same

  • The pain may increase and spread

  • You may not feel like eating and lose weight

  • The pain may make all activities, including sleeping, more difficult

 

Who should have it done?

The following groups of patients should have the procedure done:

 

  • Patients with pain in the area covered by the coeliac plexus, including the pancreas, liver and upper intestines, that has failed to respond to standard treatments

  • Patients with pain in the area covered by the coeliac plexus, with symptoms suggesting that the sympathetic nerves are involved

 

Who should not have it done?

Each patient has the final decision on whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue. There are specific medical situations when a coeliac plexus block should not be done and they are as follows:

 

  • When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor

  • When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal

  • When there is infection of the skin over the site where the needle needs to be put in; this could lead to further infection in the deeper tissues and possibly blood poisoning

  • When a patients has diseased tissue around the coeliac plexus; this could lead to a spread of the disease

 

Author: Dr Sean White FRCA. Consultant in pain and anaesthesia.

© Dumas Ltd 2006

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