Celiac ganglion blockade

CT-guided Celiac Plexus Block (Splanchnic Blockage)

Celiac Plexus Block is a very effective and safe method in relieving or reducing chronic abdominal pain caused by diseases involving the celiac ganglion. In Celiac Plexus Block, pain transmission is interrupted at the nerve station level. This process is also called Celiac Ganglion Blockage. The cause of pain is mostly advanced cancer patients (pancreas, stomach, duodenum, small intestine, liver and biliary tract cancer). In this case, relief of pain with medications is often unsuccessful.

Percutaneous (through the skin with a needle) Celiac Ganglion Block under the guidance of Computed Tomography is a very successful and safe method for relieving pain in these patients. It is also used to reduce or relieve pain in patients with chronic pancreatitis.

This procedure, which was previously performed without imaging guidance, is now performed by an Interventional Radiology Specialist in a safer and more effective way (because the target can be seen more easily) under CT guidance.

Attempt In the Computed Tomography unit images are taken, measurements and markings are made. It is possible to enter the patient with a needle from the front (abdominal region) as well as from the back (from the back region). The Interventional Radiologist, who will perform the procedure, decides the appropriate access route. The needle used is 20-22 Gauge in diameter and very thin.

The biggest advantage of anterior entry is the absence of the possibility of neurological complications. Since the patient lies on his back in the front entry, the lying position is also more comfortable. The possibility of perforation of the main artery called the aorta also disappears at the front entry.

Celiac ganglion; It lies in front of the diaphragm crus, adjacent to the bilateral anterolateral wall of the aorta, just below the celiac artery exit.

Ethanol is injected at a concentration of 50-100% in a volume of 20-50 ml as a neurolytic agent for the block. Bupivacaine or Lidocaine is used as a local anesthetic (for numbing) in celiac ganglion block.

At the end of the procedure, 75% of the patients have a slight reduction in pain, while 60% of them have a significant reduction in pain.

Hydration with normal saline can be done to relieve hypotension that may occur after the procedure. Vasoconstrictor agents can also be used for this purpose.

Complications of the procedure:

Pain: Pain may occur in the posterior abdominal wall or lumbar region, which starts during or immediately after the procedure and is caused by the natural effect of the neurolytic agent.

Diarrhea (20%): It is a self-limiting side effect that occurs with the effect of the procedure. It occurs due to sympathetic blockade and the corresponding lack of parasympathetic efferent effect. It usually passes within 48 hours.

Orthostatic Hypotension (Low blood pressure when standing up): It occurs due to loss of sympathetic tone and enlargement of the abdominal veins. It is seen in 20% of cases. It usually passes within a few hours. It is treated by giving fluids through a vein.

Neurological (nervous) complications: Complications due to nerve damage such as paraplegia, weakness in the legs, lack of sensation, and paresthesia are mostly seen in posterior (posterior) entry. Paraplegia (not holding below the waist) is seen in cases of direct injury to the spinal cord during the procedure or injection into the anterior spinal artery.

Access route complications: Injury to the liver, stomach, pancreas and intestines is extremely rare.

Other: Impotence, gastroparesis, superior mesenteric vein thrombosis, chylothorax, pneumothorax, chemical pericarditis, aortic pseudoaneurysm, aortic dissection, bleeding, and retroperitoneal fibrosis are extremely rare complications.

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