Celiac Plexus Neurolytic Block for Pain Management in
Recurrent Pancreatitis and Gastrointestinal Malignancy
Nicholas Russo D.O., Magdalena Anitescu M.D., PhD.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL

 

Celiac plexus diagnostic block helps to determine safety and pain generator in patients with altered anatomy prior to neurolytic block

 

CASE REPORT
29-year-old female with a history of colon cancer status post resection and recurrent pancreatitis

Past medical history:
• Colonic adenocarcinoma stage IIB s/p hemicolectomy
• Congenital heart disease s/p orthotopic heart transplant x2 and kidney transplant

 

TREATMENT
One stop shop: Bilateral retro-crural celiac plexus diagnostic block followed by neurolytic block immediately after positive pain relief

Bilateral celiac plexus diagnostic block
• Bupivacaine 0.25% 10 mL, lidocaine 1% 7 mL, triamcinolone 80 mg, dexamethasone 10 mg

Bilateral celiac plexus neurolytic block
• 20 mL of 99% denatured alcohol

 

RESULTS
• Decreased pain within 5 minutes following the diagnostic block
• Pain relief sustained post-neurolytic block in follow-up - steroids given with block to help with Wallerian degeneration pain
• Pain relief is temporary and patient may need splanchnic block or intrathecal pump in future

 

IMPLICATIONS
This approach confirms the target and enhances the procedure’s safety profile, especially in patients with altered anatomy

 

REFERENCES
1. Cornman-Homonoff, Joshua, Daniel J. Holzwanger, Kyungmouk S. Lee, David C. Madoff, and David Li. 2017. “Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain.” Seminars in Interventional Radiology 34(4): 376-386. doi:10.1055/s-0037-1608861.
2. Liou H, Kong MJ, Alzubaidi SJ, Knuttinen MG, Patel IJ, Kriegshauser JS. 2021. “Single-Center Review of Celiac Plexus/Retrocrural Splanchnic Nerve Block for Non-Cancer Related Pain.” Academic Radiology 28(Suppl 1):S244-S249. doi: 10.1016/j.acra.2021.03.005.

Nicholas.russo@uchicagomedicine.org