Coeliac Plexus Block
Introduction
The coeliac plexus is a bundle of nerves that controls some of the unconscious but necessary actions performed by the pancreas, liver or upper intestines. It is located near the spine at the level of the umbilicus, or what we think of as the tummy button. Technically speaking, it is located between the thoracic 12 vertebra at the bottom of the middle portion of the back and the lumbar 1 vertebra at the top of the lower back. These sympathetic nerves, meaning that they control actions that we don’t have to think about, like digestion, come together around a large blood vessel called the coeliac artery, thus giving the plexus, or bundle of nerves, its name.
What can go wrong?
Usually, the sympathetic nerves do not send pain signals to the brain, but in some cases pain signals can be “switched on” and sent anyway. Unfortunately, we do not understand why these signals can be switched on, but the medical community has learned to recognise the signs when they have been. When the pain signals are switched on from the coeliac plexus, this can result in pain coming from the pancreas, liver, and in rare cases, the upper intestines.
To make things worse, pain from sympathetic nerves usually do not respond to conservative treatments such as rest or painkillers, whether they are over the counter or stronger ones available only by prescription. Sympathetic pain can be constant or come in waves, easing off at some times, can be affected by hot or cold weather, therefore can change with the seasons, and can be related to eating or digestion. The pain coming from the coeliac plexus is found in the upper abdomen, just under the ribs. Patients often describe the pain as shooting, stabbing or sharp. As there is no test to confirm the diagnosis, doctors must be able to recognise the signs through a combination of the patient’s symptoms and the medical history.
The Procedure
A coeliac plexus block is typically performed as a day procedure. The patient is first given an IV in the back of a hand so that the doctor can administer sedation or fluids if necessary. After a local anaesthetic is injected into the back, to needles are inserted into place. Patients may feel some discomfort during this part of the procedure. A solution that shows up under x-ray, called contrast, is injected to verify that the needles have been placed in the correct position. Once both needles have been verified, a local anaesthetic and, in some cases, a steroid solution, will be injected.
After a period of time in the recovery room, most patients will be sent home the same day. They should have someone to escort them home and should be able to rest for the remainder of the day.
As for the pain, some patients will feel relief from the pain very quickly and others may not notice a difference for up to three weeks. Although this is not a permanent solution, patients may feel relief for many months before the pain returns.
