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PubMed1986

[Age and features of the content of myelinated fibers in nerves of the splenic plexus of man].

The amount of the myelin fibers (MF) has been calculated in transversal serial sections of the nervous-vascular complexes of the splenic artery in newborns, in persons of mature (the 1st and 2d periods), elderly and old ages. In each age group 20 complexes have been studied. The total amount of the MF in persons of mature age (the 1st period) in 4.2-6 times greater (initial--terminal parts of the plexus) than in newborns, in the persons of old age it is 4-2.1 times less than in persons of mature age (in both cases P less than 0.001). Thin MF predominate, their relative contents in the aggregate of all classes of the MF in newborns are 92%, in mature persons--87%, in old persons--65%. Decreasing part of the thin MF together with increase of their absolute amount in the mature persons, comparing to the newborns, depends on higher rates in differentiation of middle and thick MF. Phenotyping peculiarities and stages of productive development, stabilization (the 1st-2d periods of the mature age), involutions of the nerve connections are defined in the splenic artery. The amount of the MF predominates in the nerves of the initial part of the plexus comparing to its terminal part. There is a direct correlative dependence between the amount of the MF in the plexus nerves and the size of the lumen in the splenic artery. Changes in the amount of the MF of different classes reflects qualitative differences of the splenic innervation relations at certain stages of the human postnatal development.

Adolescent↗
PubMed1974

Paraplegia following coeliac plexus block with phenol. Case report.

Paraplegia complicating a block of the coeliac plexus with 6% aqueous phenol for carcinoma of the pancreas is described. The patient had no previous neurological abnormality and it is postulated that vascular ischaemia of the spinal cord was responsible for the sequence of neurological events.

Aged↗
PubMed1979

The treatment of severe pancreatic pain.

The management of four patients with severe pancreatic pain is discussed. Bilateral coeliac plexus block with alcohol gave effective pain relief to the three patients with pancreatic carcinoma and the one patient with acute pancreatitis. The treatment of the pain of acute and chronic pancreatitis is reviewed.

Adult↗
PubMed1976

[Conduction pathways of the solar plexus in dogs].

The conduction pathways of dog's solar plexus were studied, using the recording of action potentials of the plexus nerves. Greater splanchnic nerves consists of two groups of afferent A-fibres (conduction velocity of 12-15 and 25-56 m/s), afferent C-fibres (conduction velocity of 0.4-2.0 m/s) and preganglionic B- and C-fibres (conduction velocity of 1.0-12.0 m/s). Afferent A- and and C-fibres pass through the solar plexus ganglia to the dorsal roots; preganglionic fibres terminate synaptically on ganglionic neurons, their axons pass in the peripheral nerves to the viscera. Pathways between the peripheral nerves were found; probably they form peripheral reflex arcs.

Action Potentials↗
PubMed2000

Nitric oxide released by gastric mechanoreceptors modulates nicotinic activation of coeliac plexus neurons in the rabbit.

The effects on the nicotinic activation of the coeliac plexus neurons of nitric oxide (NO) released within the coeliac plexus by gastric mechanoreceptors, in particular during gastroduodenal inhibitory reflex, were assessed. This study was performed in the rabbit on an in vitro preparation of the coeliac plexus connected to the stomach and the duodenum. The electrical activity of ganglionic neurons was recorded with intracellular recording techniques. Water-filled balloons were used for gastric distensions and recording of duodenal motility. When a 10-s train of pulses (20-40Hz) of supramaximal intensity was applied to the splanchnic nerves, gradual depression of nicotinic activation occurred. Gastric distension (50 mL, 7.5 min) modulated this depression phenomenon by inhibiting or facilitating the nicotinic activation. In the neurons impaled during the recording of duodenal motility, gastric distension triggered an inhibition of nicotinic activation concomitantly with a gastroduodenal inhibitory reflex organized by the coeliac plexus. If the gastric distensions were performed while the coeliac plexus was superfused by a NO scavenger, the nicotinic activation was unaffected and the gastroduodenal inhibitory reflex was abolished. Moreover, when the coeliac plexus was superfused with an inhibitor of nitric oxide synthase, gastric distensions were without effect on the nicotinic activation. These results demonstrate that NO released within the coeliac plexus by gastric mechanoreceptors, in particular during the gastroduodenal inhibitory reflex, modulates the central nicotinic activation of coeliac plexus neurons, so NO released within a prevertebral ganglion by gastric afferent fibres, in particular during the organization by this ganglion of a reflex regulating the gastrointestinal tract motility, also exerts a gating of the central inputs to the ganglionic neurons.

Animals↗
PubMed1993

Coeliac plexus block with bupivacaine reduces intestinal dysfunction in neurosurgical ICU patients.

Coeliac plexus block, an established method of treatment for pain associated with pancreatitis and cancer, was used in neurosurgical patients with gastrointestinal dysfunction. The study was performed in 16 patients whose gastric reflux volume exceeded 600 ml per day for 3 consecutive days. Patients were allocated to a block group (n = 8) or a control group (n = 8). Coeliac plexus block was accomplished with a modified Moore technique using 50 ml bupivacaine 0.25%. In the block group, gastric reflux volumes for 3 days preceding coeliac plexus block and 3 consecutive days following coeliac plexus block were analysed. In the control group, gastric reflux volumes were observed over a period of 6 days. Mean (SEM) gastric reflux volume decreased significantly following coeliac plexus block from 770 (50) ml to 60 (30) ml (p < 0.01). In the control group, gastric reflux remained unchanged over the corresponding periods (730 (60) ml c.f. 670 (50) ml). The response of gastric reflux volume to coeliac plexus block suggests that the mechanism is related to inhibition of sympathetic activity in patients whose sympathetic drive is increased due to the underlying neurological disease, and possibly due to sedation withdrawal symptoms.

Adult↗
PubMed1983

A new approach to the neurolytic block of the coeliac plexus: the transaortic technique.

The present study critically examines the coeliac plexus block techniques hitherto adopted, pointing out the complications involved and stressing the seriousness of the neurological complications due to spread of the neurolytic agent to the sympathetic chain and the lumbar plexus. Contrast enhanced CT scans demonstrate the difficulties involved in confining the neurolytic agent to the anterior, peri-aortic and precrural regions. The authors report their recent experience with coeliac plexus block by means of a single transaortic needle in 28 patients. In 12 of the patients, the CT scan revealed a spread was anterior to the medial crura of the diaphragm, sometimes extending laterally towards the costovertebral gutter along the ventral surface of the diaphragm.

Aged↗
PubMed1999

Coeliac plexus block using computed tomography guidance.

Coeliac plexus blocks have been used successfully in the treatment of abdominal pain in advanced cancer and in benign chronic abdominal pain. However, concern remains about occasional potentially serious complications. One possible way to reduce the risks of this procedure may be to improve imaging during the procedure. We report a series of 38 coeliac plexus blocks carried out under computer tomographic (CT) guidance, mostly using the anterior approach. The technique is described. Effectiveness and side-effect rates were similar to other reported series. There were no major complications. Analysis of contrast spread would indicate that anterior preaortic or bilateral contrast spread is necessary to obtain pain relief. Our experience would indicate that routine CT guidance can be a simple aid to coeliac plexus block, and can be achieved easily in a district general hospital. Improved imaging allows accurate needle placement, while avoiding vital structures such as the aorta and pleura. Accurate placement may also allow the use of reduced volumes of neurolytic drugs.

Abdominal Pain↗
PubMed1993

Coeliac plexus block for chronic pain syndromes.

The purpose of this article is to familiarize the anaesthetist with the basic anatomy of the coeliac plexus; the techniques used to perform the procedure, its indications, complications and results in the management of chronic abdominal pain syndromes. Radiological, surgical and anaesthetic literature from the beginning of the century were reviewed. The main indication for neurolytic coeliac plexus block is intractable pain secondary to carcinoma of the pancreas or stomach. There appear to be theoretical advantages to techniques that result in spread of solution anterior to the aorta, such as the trans-aortic approach. These have not yet been demonstrated in any studies with large numbers of patients.

Abdominal Pain↗
PubMed2005

Multimedia article. Laparoscopic management of median arcuate ligament syndrome.

Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers or fibrous bands of the celiac nervous plexus. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting, and an epigastric bruit. Surgical management entails complete division of the median arcuate ligament. The video demonstrates the laparoscopic release of the median arcuate ligament in a patient with median arcuate ligament syndrome. The patient is a 22-year-old male with a 6-month history of epigastric abdominal pain, nausea, vomiting, a 140-lb. weight loss, and an epigastric bruit on physical exam. Aortography demonstrated a >or=90% extrinsic compression of the celiac artery. A full laparoscopic skeletonization of the celiac artery and branch vessels was performed. Intraoperative duplex U/S demonstrated flow rate reduction after the median arcuate ligament release. A postoperative CT angiogram demonstrated no residual stenosis. The patient was discharged on postoperative day 3 and remained asymptomatic after 7 months of follow-up. Laparoscopic release of the median arcuate ligament is a novel approach to the management of celiac artery compression syndrome. The role of minimally invasive techniques to manage median arcuate ligament syndrome is evolving but they appear to be a safe alternative to open surgery.

Abdominal Pain↗
PubMed1996

Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas.

BACKGROUND: Lymph node status and neural plexus invasion are the most important prognostic factors that may be amenable to surgery for carcinoma of the body and tail of the pancreas. The pattern of lymphatic spread and neural plexus invasion were evaluated by analysis of various clinicopathologic factors. METHODS: Twenty patients with carcinoma of the body and tail of the pancreas underwent pancreatectomy with systemic regional lymph node dissection at Kanazawa University Hospital. A precise evaluation of their lymph node involvement and neural plexus invasion was determined. RESULTS: Sixteen of 20 patients (80%) had lymph node involvement. The lymph nodes with a high metastatic rate were those along the splenic artery (50%), the inferior body lymph nodes (35%), the lymph nodes around the common hepatic artery (25%), and the paraaortic lymph nodes (20%). There was no relationship between tumor size, histologic type, and lymph node involvement. Plexus invasion was observed in 14 patients (70%). The most frequent site was the splenic plexus, but between 15% and 20% of the patients had celiac or superior mesenteric plexus invasion. There was no relationship between tumor size, histologic type, and neural plexus invasion. CONCLUSIONS: Based on these results, extended lymphadenectomy including the paraaortic lymph nodes, celiac lymph nodes, and superior mesenteric lymph nodes may improve the prognosis for patients with carcinoma of the body and tail of the pancreas. Extrapancreatic neural plexus dissection, especially of the celiac plexus and superior mesenteric plexus, also is necessary.

Adenocarcinoma↗
PubMed2002

Palliation by coeliac plexus block for upper abdominal visceral cancer pain.

Palliation of cancer related pain is one of the major concerns of patients suffering from cancer of the upper abdominal organs. The non-availability of imaging techniques to guide needle placement prompted us to use a blind technique of neurolytic coeliac plexus block. Thirty consecutive patients with intractable pain, due to documented inoperable upper abdominal visceral cancers, underwent neurolytic coeliac plexus block by blind percutaneous retrocrural unilateral neurolysis. The severity of pain was documented on a 0-10 visual analogue scale (VAS) performed pre-block and post-block at 1 day, 1 week, 1 month and 3 months. Pain relief was graded as excellent if the score was 0-2, good when VAS was 3-5, satisfactory whenVAS was 6-7 and unsatisfactory if VAS was 8-10. Excellent pain relief was obtained in 26/30 patients (86.6%). Relief from pain diminished with time and after 3 months, 16/30 patients (53.35) graded their pain relief as excellent. Transient but severe hypotension complicated 73% of blocks. Despite the proximity of vital structures, blind unilateral retrocrural neurolytic coeliac plexus blockade is a safe and effective means to relieve the terminal pain associated with upper abdominal visceral cancer. It deserves more widespread use in patients with upper abdominal cancer. Results of the present study are encouraging and relevant for clinicians working in developing countries.

Abdominal Neoplasms↗
PubMed2006

[Coeliac plexus block in patients with pancreatic tumour pain].

Pancreatic cancer tends to be diagnosed at a relatively late stage of the disease when curative resection is precluded. In view of the poor prognosis and the severe pain, palliative care should be aimed at providing adequate pain relief and optimal quality of life. Pancreatic cancer pain is primarily treated by the combination of NSAIDs, adjuvant analgesic drugs, and oral or transdermal opioids. The neurolytic coeliac plexus block is recommended as adjuvant therapy for the palliative treatment of pancreatic cancer pain. In addition quality of life, especially functional and physical aspects, is significantly improved in patients following a coeliac plexus block. The most common approach to the coeliac plexus is the percutaneous posterior technique. Serious complications that may follow application of this technique include sensory disorders, muscle weakness and paraparesis. More recently, new techniques such as thoracoscopic splanchnicectomy and endoscopic ultrasound-guided coeliac plexus block have emerged as efficient alternatives in terms of pain relief and quality-of-life improvement. The neurolytic coeliac plexus block has become a well-developed method of pain relief in patients with pain resulting from malignancies of the pancreas. To define the role of these new techniques in the palliative treatment of pancreatic cancer pain, comparative studies regarding efficacy, side effects, and complications have to be performed.

Analgesics↗
PubMed1983

[Polymorphism of the solar plexus in swine].

The author studied the coeliac plexus and coeliac and mesenteric ganglion in 14 swine bodies. In 42.85% the left ganglion had a long form, in 21.42% a strangled form and in 35,71% was connected to the right ganglion. The right ganglion in 71.42% had a complex form and in 28.58% a stellary form. Invariably, the right ganglion was placed posteriorly to the left ganglion.

Animals↗
PubMed1992

Sonographically guided coeliac plexus block.

A sonographically guided anterior approach to block the coeliac plexus with local anaesthetic was attempted on supine patients before hepatobiliary interventional procedures. A satisfactory block was achieved in 8/9 patients and the minor complication of transient hypotension was encountered in two which were managed conservatively. Comparison with controls showed the coeliac block patients to require significantly less intravenous sedation and analgesia to control pain during these procedures.

Abdomen↗
PubMedDate not supplied

[Electrical potentials of the vagal and sympathetic pathways of the stomach during elaboration of conditioned reflexes].

In chronic experiments on dogs discharges were recorded in efferent fibers of the vagal and splanchnic nerves and gastric branches of the solar plexus in the form of slow low-voltage and rapid high-voltage potentials. Alimentary conditioning to a previously indifferent stimulus produced a clear efferent reaction expressed in an increased number of oscillations. The magnitude of efferent electrical responses in all the examined structures is dissimilar and depends on the nerve nature (sympathetic or parasympathetic). The greatest electric reactions occur in the vagal gastric pathways.

Animals↗
PubMedDate not supplied

[Effect of apressin on the mechanism regulating vascular tone].

Acute experiments with anesthetized and decerebrate cats brought evidence that in a dose of 1 mg/kg apressin first increases by 50 per cent the centrogenically-produced pressor vascular reactions and then (30-60 min thereafter) suppresses pressor responses. Apressin (in a dose of 3-5 mg/kg) appreciably weakens the intensity of the pressor vascular reactions and increases the efferent outflow in the renal nerve. In doses of 1-10 mg/kg it does not affect the transmission of excitation in the superior cervical sympathic ganglion and in the solar plexus nodes. In tests with the crossed circulation apressin in doses of 1 and 5 mg/kg produces a marked depression of vascular reactions and a drop of the perfusion pressure in the vessels of the hind extremity perfused with the autoblood and a rising intensity of these reactions along with a greater resistance of the hind extremity vessels, perfused with the donor's blood.

Animals↗