Pain sensation from organs in the upper part of the abdomen (the stomach, liver, pancreas and duodenum) are conveyed to the spinal cord via nerves that are part of the sympathetic nervous system. These are separate from those that carry sensation from the overlying skin and muscle around the abdominal wall. They pass back to the spinal cord via a network of nerves just in front of the big artery running down through the abdomen (the aorta) called the Coeliac plexus.

A procedure called a coeliac plexus block can be used to permanently numb the sensation carried in these nerves. This is usually used in the treatment of severe pain resulting from tumours in the organs supplied by the coeliac plexus, most often the pancreas.

The procedure is done under local anaesthetic with or without some sedation. With the patient lying on their front, under guidance from an X-Ray machine, one or two fine needles are inserted just under the bottom of the ribcage and directed forward to lie just to either side of the aorta, in the area of the plexus (an alternative technique is to deliberately pass the needle through the aorta to end up just in front of it).

Once injection of X-ray dye confirms the correct position, local anaesthetic and then alcohol is injected to first numb and then kill the nerves.

This procedure has a good success rate in treatment of severe cancer pain from the pancreas and other organs supplied by the coeliac plexus.  It is less effective for inflammatory conditions of the pancreas (chronic pancreatitis) and is rarely used for this.

It does have some side-effects: there is a potential to cause bleeding from the local blood vessels, and the effect on the nerves can lead to a tendency for the blood pressure to drop on standing up in the first few days. Sometimes it can also lead to diarrhoea after the procedure. Very occasionally it can lead to temporary weakness of the legs afterwards, and in a very tiny number of cases this weakness can be permanent.

(Please see general comments on the Procedures page: for coeliac plexus block with alcohol for cancer pain we would normally arrange for patients to stay in hospital for the night afer the procedure)

Further Reading

A technical description of the procedure is given on the Anaesthesia UK website

The Trust's information sheet on Coeliac Plexus Block can be downloaded here

 

 

 

 

 

 

 

 

 

 

 

Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk