Celiac Nerve Block
Patients with advanced stages of chronic pancreatitis may fail to have adequate control of pain with oral drug therapy. In these patients, more aggressive intervention is required. In cases of intractable pain, injection of a local anesthetic around the nerve temporarily inhibits nerve fibers from transmitting pain messages. Celiac plexus blocks are a sufficiently safe and effective treatment for the management of abdominal pain. This treatment, however, provides short-term relief and repeat procedures may be necessary.
Pain management in chronic pancreatitis may employ a neurolytic substance like ethanol. Neurolytic blocks should be used in a multimodal approach to control pain and not as a "cure." Ethanol has been used extensively in neurolytic procedures to destroy nerve tissues by extraction of cholesterol and other lipids and by protein precipitation.
The celiac plexus is located on the anterolateral surface of the aorta at the T12 to L2 spinal level. Celiac plexus block reduces pain from abdominal organs. This form of pain treatment has gained acceptance for the treatment of chronic pancreatitis. An 84% incidence of pain relief has been reported with celiac plexus block, although occasionally repeat blocks are necessary.
Celiac plexus block can be performed by three different approaches. One approach (percutaneous) is performed by an anesthesiologist who passes a needle through the skin into the celiac plexus (Figure 25A). This procedure is low risk and performed on an outpatient basis in 30–60 minutes. A second approach is to inject the celiac plexus during surgery while the abdomen is open (Figure 25B).
The final approach is using endoscopic ultrasound guidance to insert the needle into the celiac plexus (Figure 25C).