Celiac plexus block: efficacy and safety of the anterior approach

A celiac plexus block performed via an anterior approach offers several potential advantages over a posterior approach, including shorter procedure time, less discomfort to the patient, and less risk of neurologic complications. We evaluated the use of an anterior approach to determine its efficacy and safety.

The procedure was performed in 17 consecutive patients referred for treatment of chronic abdominal pain thought clinically to be of celiac ganglion origin. A subjective evaluation of the degree of pain relief was obtained by retrospectively reviewing the notes of physicians and nurses. The degree of pain relief was graded from 1+ (no change) to 4+ (complete relief). An objective evaluation was also obtained by comparing average daily in-hospital analgesic usage before and after the procedure.

Ethanol injection was performed successfully in 13 of 14 patients with pancreatic carcinoma and in two of three patients with other causes of pain. Eleven (79%) of the 14 patients with pancreatic carcinoma had some (2+ or greater) relief of pain, and eight of these patients had considerable or complete (3+ or 4+) relief of pain. Of the 10 patients with pancreatic carcinoma for whom complete data on the use of pain medication were available, the mean daily analgesic usage declined from 17% to 100% (mean, 58%) relative to preprocedure doses. Complications, all relatively mild, were encountered in only three of 17 patients, and no patient had neurologic symptoms or long-term sequelae.

The anterior approach to a celiac plexus block is a safe and effective means of pain control in patients with pancreatic carcinoma. It offers several potential advantages to the posterior approach, and should be considered for all patients with pain caused by pancreatic carcinoma that is refractory to pain medication.