CELIAC GANGLION BLOCK

What is Celiac Ganglion Block?

Celiac ganglion block is a procedure used to alleviate chronic abdominal pain, especially in patients with advanced cancer that originates from upper abdominal areas like the pancreas, stomach, duodenum, proximal bowel, liver, or biliary tract. Since traditional treatments like medication or radiotherapy may not effectively manage this pain, celiac ganglion block offers an alternative for patients with inoperable abdominal malignancies.

The procedure involves using a 22-gauge Chiba needle guided by CT scans to access the celiac ganglia, located near the origin of the celiac trunk and superior mesenteric artery. A mixture containing about 50% alcohol, 5% contrast, and the rest of normal saline is injected into this area. This causes a blockage of nerve signals, reducing pain significantly in around 95% of patients post-procedure.

However, one common side effect is temporary diarrhea, affecting up to 75% of patients, typically resolving within 48 hours. Despite this, celiac ganglion block remains a valuable tool in improving the quality of life for cancer patients experiencing severe abdominal pain.

Diseases Treated by Celiac Ganglion Block

The celiac nerve block is utilized to manage several conditions that cause abdominal pain and discomfort. These include:

• Cholangiocarcinoma: A type of bile duct cancer that can lead to severe abdominal pain.
• Recurrent abdominal pain: Chronic or intermittent pain in the abdomen, often of unknown origin.
• Crohn’s disease: An inflammatory bowel disease that causes inflammation and ulcers in the digestive tract.
• Gastrointestinal cancer: Various cancers affecting the gastrointestinal tract, such as stomach cancer, may cause significant abdominal pain. Inflammatory bowel disease: Including conditions like ulcerative colitis and Crohn’s disease, which cause chronic inflammation in the digestive tract.
• Pancreatitis: Both acute pancreatitis (sudden inflammation of the pancreas) and chronic pancreatitis (long-term inflammation) can result in severe abdominal pain, which may be managed with a celiac nerve block.

By targeting the nerves responsible for transmitting pain signals from these conditions, the celiac nerve block can effectively alleviate abdominal pain and improve the patient’s quality of life.

How Does it Work?

During a nerve block procedure such as the celiac nerve plexus block, several steps are involved to effectively target and alleviate pain. The procedure typically begins with the patient lying either prone (on their stomach) with a bolster for support or supine (on their back) if lying prone is too uncomfortable. An intravenous sedative is administered to induce relaxation.

Using imaging scans such as fluoroscopy X-rays, a CT scan, or endoscopic ultrasound, the healthcare provider guides the procedure to ensure accuracy. The treatment area is sterilized, and a local anesthetic is applied to numb the site of injection. A needle is then inserted into the back, and the provider confirms its correct placement by injecting a contrast dye visible on the imaging scan, causing minimal discomfort.

Once confirmed, the provider switches to a different needle to administer either a pain-relieving medication (anesthetic) or a steroid to numb the nerves and reduce inflammation. In some cases, alcohol may be injected for a neurolytic procedure, damaging the targeted nerves and interrupting the transmission of pain signals to the brain. This process effectively blocks the celiac plexus pain sensation, providing relief for conditions such as cholangiocarcinoma, Crohn’s disease, and pancreatitis.

Post Recovery

After receiving a celiac block for pancreatic pain, most individuals experience pain relief within 15 to 30 minutes. However, it’s standard procedure to remain at the medical facility for 1 to 2 hours post-procedure to monitor for any potential complications.

Common side effects following a nerve block may include bruising, swelling, or soreness at the injection site. Although rare, there is a risk of infection at the treatment site, which would require prompt medical attention if suspected. Some individuals may also experience temporary diarrhea, possibly due to the effects of the medications used during the procedure. 

Additionally, nerve blocks can sometimes cause a temporary drop in blood pressure or lead to muscle spasms. These side effects are usually mild and resolve on their own without intervention.

It’s crucial to follow any post-procedure instructions provided by your healthcare provider, including restrictions on activities or nerve blocker medications to take or avoid. If you experience any severe or prolonged side effects, you can visit Dr. Manohar Kanwaria promptly for further evaluation and management.

FAQs

1. What are the potential risks or side effects of a celiac ganglion block?

While celiac ganglion blocks are generally safe procedures, they do carry some risks. These can include temporary numbness or weakness in the legs, infection at the injection site, bleeding, allergic reactions to medications used during the procedure, and, rarely, damage to nearby structures such as blood vessels or nerves.

2. How long does pain relief from a celiac ganglion block last?

The duration of pain relief can vary from person to person. Some individuals may experience immediate and long-lasting relief that lasts for weeks or months, while others may require repeat injections for sustained pain management. Your healthcare provider will monitor your response to the procedure and adjust your treatment plan accordingly.

3. Is a celiac ganglion block a permanent solution for abdominal pain?

A celiac ganglion block is not typically considered a permanent solution for abdominal pain. While it can provide significant relief, especially in cases of severe pain from conditions like cancer, the effects are often temporary. Repeat injections or other pain management strategies may be necessary to maintain pain control over time.

4. Can a celiac ganglion block help with digestive symptoms in addition to pain relief?

While the primary goal of a celiac ganglion block is pain management, some patients may also experience improvements in digestive symptoms such as nausea, vomiting, and diarrhea. This is because the celiac ganglion plays a role in regulating the function of organs in the abdominal region, including the stomach and intestines.

5. Are there any special considerations for undergoing a celiac ganglion block procedure?

Patients considering a celiac ganglion block should inform their healthcare provider about any allergies, medications they are taking, or existing medical conditions. It’s also important to follow pre-procedure instructions, such as fasting beforehand if required, and arrange for transportation home, as the procedure may cause temporary drowsiness or weakness.

6. What alternatives are there to a celiac ganglion block for managing abdominal pain?

In addition to celiac ganglion blocks, there are other pain management techniques for abdominal pain, including medication management, nerve blocks targeting different nerve clusters, spinal cord stimulation, and even surgical interventions in certain cases. The choice of treatment depends on the specific condition, severity of pain, and individual patient factors.

 

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