MANAGEMENT OF CHRONIC POSTSURGICAL
ABDOMINAL
PAIN USING CELIAC PLEXUS BLOCK
WITH BOTULINUM
TOXIN A

PRESENTER:
Shawn Shoham, DO
shohamshawn@uams.edu

 

BACKGROUND
Chronic focal abdominal pain presents a challenge in pain management and is
often resistant to conventional approaches. Botulinum Toxin A (BoNT-A)
functions by binding to presynaptic nerve endings, blocking the release of
acetylcholine. It has shown effectiveness in treating dystonia and can induce
sympathetic blocking by targeting cholinergic presynaptic fibers at sympathetic
ganglia.
REPORT & RESULTS
• 61-year-old female with severe and localized right upper quadrant (RUQ)
abdominal pain following cholecystectomy for several years.
• Multiple specialists were seen across states. Extensive GI workup, including
exploratory laparotomy, MRI/MRCP, and CT scans, excluded anatomical and/or
infectious etiology.
• Treatment regimen included opioids, muscle relaxants, anti-inflammatories and
medical marijuana.
• Opioid requirement was 15 MME/day. Patient was very active and an avid
traveler, limited by pain and frustrated by being dependent on medications.
• A Celiac Plexus block with local anesthetic first provided >95% pain improvement
for 24 hours.
• The block was then repeated with 20 units of BoNT-A injected along with 1cc of
0.5% bupivacaine. A retrocrural approach was utilized, with entry at the level of
the right L1 vertebral body
• The patient experienced a sustained reduction in pain levels, exceeding 80%, which
endured over several months.
• During this period, she was weaned from her opioid pain medications.
• She experienced an increase in activity and functionality and improved sleep
uninterrupted by pain
• Block has been repeated for this patient as needed, dosages increased to 25u, with
effects lasting an average of 4-6 months.
DISCUSSION
We highlight the efficacy of a celiac plexus block with BoNT-A as a promising
intervention for chronic focal abdominal pain. This technique's success suggests a
possible link between nerve-mediated pain pathways and the targeted
neuromodulatory effects of BoNT-A. Future research should delve into the
underlying mechanisms, refine procedural protocols, and explore its broader
application in chronic pain management.