General overview and orientation to the celiac ganglion block.

1. CELIAC
GANG
BLOCK
PAIN MANAGEMENT/UTMB-GALVESTON
DENNIS GRAY, DO, PGY-1

2. ANATOMY

3. DISCLOSURE
I HAVE NO FINANCIAL TIES TO DISCLOSE

4. INDICATIONS
• Acute or chronic pancreatitis
• Pancreatic cancer
• Intra abdominal METs disease
• Diagnostic block: visceral vs. abdominal wall pain
• Adjunct to surgery

5. NEUROLYTIC AGENTS
• 0.25-0.5% marcaine + 80mg methylpred
• 6-10% phenol
• 50-100% EtOH

6. LANDMARKS

7. INSTRUCTIONS

8. INSERTING SECOND
NEEDLE ON THE RIGHT

9. PIERCING THE
DIAPHRAGM

10. CONTRAST

11. COMPLICATIONS
• 0.15-1.0% complication rate
• Pneumothorax
• Chylothorax
• Nerve injury including paralysis
• Retroperitoneal fibrosis
• Aterial vasospasm resulting in ASA syndrome
• Common
• 96% local pain
• 44% diarrhea
• 38% hypotension

12. SUCCESS RATE
• Eisenberg et al:
• Adequate-excellent pain relief within first week: 89%
• 70-90% continued to have pain relief at 3 months

13. REFERENCES
Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus
block for treatment of cancer pain: a meta-analysis. Anesth
Analg. 1995;80:290-295.
Mercadante S, Nicosia F. Celiac plexus block: a reappraisal. Reg
Anesth Pain Med. 1998;23:37-48.
Ward EM, Rorie DK, Nauss LE, et al.The celiac ganglion in man:
normal anatomic variations. Anesth Analg 1979;58:461
Ischia S, Luzzani A, Ischia A, et al. A new approach to the
neurolytic block of the coeliac plexus. The transaortic technique.
Pain 1983;16:333.