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
