What is a Celiac Plexus Block?
Celiac plexus block is a pain management and pain treatment procedure used to numb nerves in the upper abdomen and around the aorta in circumstances of intolerable abdominal pain. The celiac plexus block procedure is most frequently used in patients where other pain medications or other less invasive therapies are ineffective. Such pain may result from irritation, compression or entrapment of the nerve bundles due to tumor invasion, fibrosis, or chronic inflammation in such settings as chronic pancreatitis or Crohn’s disease, among others. In particular, pain due to pancreatic cancer responds very well to celiac plexus blockade.
The plexus is located along the side of your spine. Local anesthetic is injected if a diagnostic block is performed to help determine the source of your abdominal pain. Alcohol is injected to destroy the nerves when a neurolytic block is performed, usually for patients with cancer. A diagnostic block is often done prior to a neurolytic block to ensure that pain relief can be achieved by this type of injection. Your doctor will tell you if you are an appropriate candidate for a neurolytic block.
What are the risks of the procedure?
As with most procedures, there is a remote risk of bleeding, infection, nerve injury or allergic reactions to the medications we use. In addition, the injections may cause some soreness in your back, which can last up to one week. Using an ice pack should help. There is also a chance that the procedure will not relieve your pain.
Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. Please make Dr. Dominguez aware of any of these conditions. In addition you may not receive anesthesia if you fail to follow the preoperative instructions with respect to eating. These instructions are for your safety!
How do I prepare for my procedure?
No solid food or fluids after midnight prior to the procedure unless directed otherwise. On the morning of the procedure, you may take your non-pain medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before coming in. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, Aspirin or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication. Please make Dr. Dominguez aware that you are taking a blood thinner, and contact your primary care physician or prescribing physician before stopping this medication.
What happens during the procedure?
After checking in and signing a consent form, you will have an IV placed, through which you will be given IV fluids prior to the procedure to minimize the drop in your blood pressure.
In the procedure room, you will be positioned on your stomach. The Anesthesiologist will sedate you with medication in your IV to make you comfortable. Your back will be cleaned with a special solution. Dr. Dominguez will then use an X-ray (fluoroscope) machine to pinpoint the exact location of the celiac plexus as it relates to your spine and the needles he is using.
Dr. Dominguez will numb your skin, which will sting for a short moment. Usually one or two needles are used, one from each side of your body at most. The positioning of the needles is confirmed by injecting dye through them that he can see under the fluoroscope. Please tell Dr. Dominguez if you are allergic to contrast dyes. Once Dr. Dominguez confirms that the needle(s) are in the correct location, the injection will be performed with local anesthetic, and then followed with alcohol if you are having a neurolytic block. Then, your skin will be cleansed and you will be taken to the recovery room.
If a neurolytic block was performed, we may need to keep you lying facedown for up to 45 minutes. Your blood pressure will be closely monitored. You will be discharged home when you are stabilized and meet discharge criteria.
Will I have any restrictions after the procedure?
Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you can do whatever you feel up to doing.
Your pain may improve immediately after the injection, or it may take a few days if alcohol was used. You should take your normal pain medicines. Dr. Dominguez will also give you a prescription for a short course of pain medicines, if needed following the procedure.
When Should I Call American Pain Institute?
We would like to speak to you the day after your procedure regarding your response. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain level, and if you are experiencing any problems. If you experience severe pain, new numbness or weakness of your legs, a temperature of 100.5 or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call our office immediately.