Celiac plexus block: a reappraisal

Abstract

Background and objectives: The neurolytic celiac plexus block is an established, well-developed procedure and the most widely applicable of all the neurolytic pain blocks. It optimizes palliative treatment for cancer of the upper abdominal viscera. Several techniques have been proposed in an attempt to increase success rates, reduce morbidity, and enhance technical accuracy. However, the assessment of the results and effectiveness of the block have been controversial.

Methods: A survey was made of pertinent English language literature on the anatomic and technical problems, indications, advantages, complications, and outcomes related to the neurolytic celiac plexus block as well as the neurolytic solutions and radiologic guidance used.

Results: The successful relief of the pain of pancreatic cancer and other abdominal malignancies can be expected in 85% and 73% of patients, respectively. Following the block, many patients can be weaned from opioids or at least have their dose reduced. The half-life of the celiac plexus block seems to be more than 4 weeks. The probability of patients remaining completely pain-free diminishes with increases survival time. The technique selected should be appropriate to the available and the extent of malignancy, since the analgesic results seem to be independent of the principal techniques used. Serious complications are extremely rare. However, critical analysis revealed major deficiencies in all of the reports reviewed.

Conclusion: Neurolytic celiac plexus block alone is capable of providing complete pain relief until death in a few cases and, therefore, should be considered as an adjuvant treatment in the analgesic strategy. Combination palliative therapy is necessary in most cases. Failure of the block may be attributed to tumor metastasizing beyond the nerves that conduct pain via the celiac plexus and the component nerves that form it. Concomitant pain of somatic origin (frequently observed in upper gastrointestinal cancer because of significant peritoneal involvement) requires other therapeutic measures.