3.4 Coeliac Plexus

Question 1

Indications

Answer 1

Diagnostic and therapeutic

Analgesic + Neurolytic

Analgesic:

1. Dx chronic pain Synd
   Confirmation sympathetic mediated
   chronic pain syndrome - blockade of plexus
2. Chronic abdo visceral pain
   Pancreatitis
   < effective vs malignant
3. Acute pain
   Postop laparotomy patients
   combo intercostal block

Question 2

Neurolytic

Answer 2

1. Malignancy
   Pancreatic Ca
   commonest
   any Abdo viscera affected
2. Pain relief - good - 90% patients

Question 3

Technique for blocking ganglion

Answer 3

Posterior retrocrural approach:

patient is given prone position,

and a pillow under the abdomen
is used to eliminate lumbar lordosis.

a 20-G, 10–15 cm needle is
inserted on the left side at 45° angle
toward the body of L1.

X ray screen confirms as position as advanced

Bony contact should be made at an
average depth of 7–9 cm
(superficial bony contact at 5–6 cm means hitting transverse process and should never be accepted).

The needle is then withdrawn and redirected
to slide off the tip past the vertebral body anterolaterally.

It is then advanced 1.5–2 cm past this point to feel transmitted aortic pulsations along the needle

Position can be confirmed with contrast

After checking for blood, CSF and urine, a test dose is given. The main dose is given after this incrementally.

Question 4

Complications

Answer 4

Sympathetic block:

hypotension

Haematoma

Bleeding

Aortic/inferior vena cava puncture

Paraplegia (due to puncture of artery of Adamkiewicz)

Question 5

Neurological

Answer 5

Lumbar plexus block,
Spread to epidural space
Intrathecal spread

Question 6

Complications of celiac plexus block

Damage to visceral

Answer 6

Kidney,

ureter,

adrenal,

bowel,

stomach,

Pneumothorax

Chylothorax

Question 7

Complications of celiac plexus block

Answer 7

infections

unopposed parasympathetic: diarrhoea

alcohol intoxication or acetaldehyde syndrome.

Question 8

Complications

Answer 8

Also class as immed / early / late