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Results for “CELIAC PLEXUS”

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PubMedDate not supplied

Continuous celiac plexus block in acute pancreatitis.

BACKGROUND AND OBJECTIVES: Effective management of severe pain in acute pancreatitis is one of the important issues in therapy, as pain reflexes can contribute to the development of life-threatening secondary complications. Although opioid derivatives are still clinically in use, the direct interruption of afferent nociceptive visceral stimulation (e.g., by segmental epidural block) is claimed to be much more effective method of pain relief. However, in a group of the patients with alcohol ingestion as the etiology of pancreatitis and history of drug/opioid addiction in the background, epidural block failed to alleviate the pain. Study aim was to assess the effect of continuous celiac plexus block as an alternative analgesic method in patients with acute pancreatitis by using a retrospective analysis. METHODS: Of 43 patients admitted to the intensive care unit with acute pancreatitis, 7 who did not respond to routine segmental T5-L2 epidural block received a continuous celiac plexus block performed in the right lateral position as an alternative method of pain relief. RESULTS: Intermittent or continuous unilateral celiac plexus block offers an effective alternative treatment for pain in acute pancreatitis, especially in patients with alcohol etiology and history of drug/opioid addiction, in whom the conventional methods fail to give proper pain relief.

Acute Disease↗

PubMedDate not supplied

Plasma concentrations of bupivacaine in celiac plexus block.

BACKGROUND AND OBJECTIVES: Following stellate ganglion block, systemic absorption of local anesthetics is rapid. Pharmacokinetic data for local anesthetics following other blocks, such as celiac plexus blocks, are lacking. METHODS: Plasma concentrations of bupivacaine in venous blood samples following celiac blocks were measured in 10 patients using a high-performance liquid chromatography technique; 40 mL plain bupivacaine 0.25% was administered. RESULTS: Celiac plexus block resulted in maximum plasma concentrations of 0.7-2.5 mg/L bupivacaine (mean, 1.5 +/- 0.6 mg/L). In 3 of 10 patients plasma concentrations above 2 mg/L occurred. The maximum concentrations were reached 10-30 minutes after the injection (17 +/- 8 minutes). No clinical signs of central nervous system toxicity occurred. All patients showed hemodynamic stability following the blocks. CONCLUSIONS: Maximum plasma concentrations of bupivacaine occur rather late following celiac blocks compared to stellate ganglion or intercostal blocks. The rather high plasma concentrations of bupivacaine indicate the need for appropriate clinical monitoring.

Adult↗

PubMed1978

[Synaptoarchitectonics of the ganglia of the celiac plexus in white rats].

In 50 intact white rats at the age of 6, 15, 23 and 30 months synapsoarchitectonics of the celiac plexus nodes was studied by an electron microscopy method. Peculiarities in synapsoarchitectonics are stipulated by pericaryon processes in neurons, some of them have no contacts with the axonal terminals, while others have contacts with the axonal terminals. The former include small (about 0.5 mkm) drop-like and large (up to 1.5 mkm) polymorphous processes within the limits of perisomatic membrane, as well as processes penetrating the neuronal capsule. All of them contain, in different combinations, vesicles, ribosomas, fibrillae, and the largest processes--small cisterns of granular cytoplasmatic network and single mitochondria. The processes of the first group are considered as original stages for the development of the second group processes. The latter are represented by different in size (about 1.0--2.0 mkm) in form (digital, cone-, pin-, goblet-shaped, cylindrical, branching) and in content formations. There is, as a rule, one contact on the processes of an uncomplicated form, while on the branching processes there can be up to three and more contacting axonal terminals. Peculiar features in the composition of the processes taken as a whole (specific forms, absence of dendritic tubes, sometimes numerous contacts with axonal terminals in spite of small size) distinguish them from newly forming dendritic processes and these formations are considered as independent specialized receptor apparatus in the pericaryon of neurons of the celiac plexus.

Animals↗

PubMed1993

[Percutaneous neurolysis of the celiac plexus. Description of a new CT-guided technique and preliminary results].

June 1991 to June 1992, twelve CT-guided percutaneous celiac plexus neurolyses were performed by a new simplified technique with the patient in left-hand side decubitus and a single right lumbar needle access. CT guidance allows the interventional radiologist to locate the best access point on the skin, to give the needle the appropriate depth and inclination to avoid passing through pleura, parenchyma and vessels, and finally to check the correct position of the needle tip and the spread of neurolytic solution. In left-hand side decubitus, fat and loose connective tissue around ganglia and vessels expands much more, thus allowing the alcohol-contrast medium solution to spread easily and evenly getting to both celiac ganglia by gravity. The analgesic value of celiac plexus neurolysis has been proved complete and lasting. The technique is quick and safe (apart from inevitable hypotension due to splanchnic vasodilatation).

Abdominal Neoplasms↗

PubMed1993

[Selective proximal vagotomy in combination with prolonged drug blockade of the celiac plexus in the treatment of patients with duodenal ulcers].

The work deals with the results of SPV in combination with prolonged drug blockade of the celiac plexus in 78 patients with duodenal ulcers. The motor activity of the antral part of the stomach intensified and its blood supply increased after blockade of the celiac plexus. The course of the immediate postoperative period improved after SPV and the number of patients with hypokinesia of the stomach reduced.

Autonomic Nerve Block↗

PubMedDate not supplied

[Percutaneous neurolysis of the celiac plexus under CT guidance in the invasive treatment of visceral pain caused by cancer].

To verify the effectiveness and the incidence of complication in the transcutaneal celiac plexus block with CT-guided in the patient with intractable upper abdominal cancer, using alcoholic solutions to different concentrations (50% and 96%), previous insertion of the peridural catheter. From December 1997 to June 2002, studies were carried out on 24 patients with CT-guided percutaneous coeliac plexus neurolysis including 17 men and 7 women with inoperable abdominal malignancy and two with chronic pancreatitis. The patients were affected by very intense pain controllable only with high doses of analgesic narcotics. Before the procedure a catheter was installed in the peridurale space between L1-T12. To avoid general anesthesia, 40 mL of marcaine 0.5% was injected to relieve the back pain sometimes reported after the neurolysis, caused by the diffusion of alcohol in the coeliac plexus. This technique requires a posterior percutaneous procedural transaortic approach CT scan guided, to determine the correct position of the needle tips and the spread of neurolytic solution (40 mL of 96% + 3 mL of contrast medium) around the origin of the coeliac trunk's anatomical center of the plexus. The first 10 patients have received 40 mL of 50% ethyl alcohol + 3 mL of contrast medium. To evaluate the rate of the analgesia relief, a visual analogue pain score (VAS) was used before and 48 hours after the neurolysis. The percutaneous neurolysis of the celiac plexus is useful to relieve the pain in patients affected by cancer developing in upper abdomen. The CT-scan guide of the needle allows an omogeneous distribution of the contrast medium. The insertion of the peridural catheter made a complete analgesia and reduced the incidence of complications. Our method provided an excellent control of the pain in all patients. In our experience the pain relief was almost complete in patients treated with 96% ethyl alcohol solution (VAS from 8 before the treatment to 1, 48 hours after the treatment). The alcohol administered in elevated concentrations (96%), does not increase the incidence of complications.

Abdominal Neoplasms↗

PubMedDate not supplied

A retrospective analysis of neurolytic celiac plexus block for nonpancreatic intra-abdominal cancer pain.

Neurolytic celiac plexus block (NCPB) has been reported to be an effective method for pain relief for a variety of intra-abdominal malignancies, especially pancreatic. In spite of this, few data exist concerning efficacy of the block for pain related to other intraabdominal tumors. The author analyzed the quality of pain relief obtained and complications during the use of NCPB in 66 patients with nonpancreatic intraabdominal malignancies. Seventy-three percent of the patients with nonpancreatic cancer pain had good pain relief, which in 59% of cases lasted through the remaining life of the patients. The incidence of neurologic injury (footdrop) was less than 0.5%. This therapy deserves more widespread use in patients with abdominal pain secondary to a variety of other malignancies, in addition to that of the pancreas.

Abdominal Neoplasms↗

PubMed2001

[Ultrasound guided alcohol ablation of the celiac plexus in oncology patients with abdominal pain].

PURPOSE: The authors report results of a retrospective study evaluating the efficacy of US-guided alcohol ablation of the celiac plexus in 26 patients with chronic cancer-related abdominal pain. They review the interest of this imaging technique for guidance. PATIENTS AND METHODS: Thirty US-guided alcohol ablations were performed in 26 patients. Twenty-two of them had a prancreatic malignancy, 3 had a gastric cancer and 1 had an esophageal cancer. RESULTS: 72% of patients experienced significant pain relief with at least 50% decrease in morphine requirements for two months. Four patients underwent a second ablation because of persistent pain and 3 of them experienced relief. CONCLUSION: Celiac plexus ablation is considered to be one of the most effective treatments for chronic cancer-related abdominal pain, often used as an adjuvant treatment in the pain management strategy. US guidance is advantageous because it is simple and accurate and enables quick needle placement.

Aged↗

PubMed1991

Aortic pseudoaneurysm secondary to celiac plexus block.

Traumatic pseudoaneurysm of the abdominal aorta has been infrequently reported in the literature. We report a case of an infected pseudoaneurysm of the supraceliac aorta which we believe to be secondary to celiac plexus block performed for pain from chronic pancreatitis. The aneurysm was successfully repaired using a Dacron graft through a thoracoabdominal approach. The possible mechanism of aortic injury from celiac plexus block is discussed.

Aneurysm↗

PubMed1989

Celiac plexus block following high-dose opiates for chronic noncancer pain in a four-year-old child.

This is the first case report documenting the use of a neurolytic celiac plexus block for relieving chronic noncancer pain in a pediatric patient. The child was a 4-yr-old male with an unknown form of inflammatory bowel disease since 1 yr of age. Chronic abdominal pain became a problem at 3 yr of age, following multiple bowel resections; continuous intravenous narcotic administration was implemented for pain control. The patient's pain became refractory to high-dose morphine administration (maximum dose, 267 mg/kg/day, iv), and, for that reason, a CT-guided neurolytic celiac plexus block was performed. This procedure resulted in improved pain control along with a major reduction in narcotic use to 7 mg/kg/day of morphine.

Celiac Plexus↗

PubMed2000

CT-guided celiac plexus block for intractable abdominal pain.

Treatment of intractable abdominal pain due to inoperable intraabdominal malignancy is important, and the ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions as a treatment. The author describes the technique and results of celiac plexus neurolysis under CT-guidance with various approach routes, including anterior, posterior and transaortic routes. Twenty-eight patients, ranging in age from 36 to 82 years, have been treated with this procedure. All had inoperable or recurred intraabdominal malignancies and suffered from intractable upper abdominal pain and/or back pain. The author performed the procedure using absolute alcohol by an anterior approach (n=18), posterior approach (n=6) and transaortic approach (n=4). Pain was rated according to a visual analog scale before and after the procedure to gauge treatment success. No major complications occurred. Mild hypotension occurred in five patients (18%) and transient diarrhea in six patients (21%). Twenty-one (75%) of the 28 patients had some relief of pain and 17 of these patients (61%) had good relief of pain after the procedure. The results support that CT-guided celiac plexus block with alcohol is a safe and effective means of pain control in patients with intraabdominal malignancy.

Abdominal Pain↗

PubMed2001

Computed tomography-guided neurolytic celiac plexus block with alcohol complicated by superior mesenteric venous thrombosis.

Neurolytic celiac plexus block (CPB) under radiological guidance is often performed to manage pain associated with pancreatic cancer. Serious complications related to the block are rare. Computed Tomography (CT)-guided neurolytic CPB is advocated to improve the efficacy of the block and to reduce the incidence of associated complications. We describe a case of superior mesenteric vein thrombosis associated with neurolytic CPB performed under CT guidance.

Autonomic Nerve Block↗

PubMedDate not supplied

Ultrasonic guidance of lumbar sympathetic and celiac plexus block: a new technique.

BACKGROUND AND OBJECTIVES: Lumbar sympathetic and celiac plexus block are widely used to treat chronic pain of diverse etiologies. To avoid complications and confirm the correct position of the needle, fluoroscopy and computed tomography have been used to follow the procedure visually. Our objective was to examine whether ultrasonography could be used instead of these techniques. METHODS: Forty-eight neurolytic sympathectomies were performed using ultrasonographic guidance. The results were evaluated clinically and by color-doppler technique as applicable. RESULTS: This new technique was shown to provide excellent results in ensuring the safe passage of the needle and documenting the correct spread of neurolytic agent (phenol-glycerol). The correct position of the needle was achieved on the first attempt in all cases. CONCLUSIONS: The benefits of this technique are that it is inexpensive, there is no radiation, and the anatomy involved can be thoroughly examined before and after the procedure. Phenolglycerol may be the best choice as the neurolytic agent because it provides excellent contrast.

Autonomic Nerve Block↗

PubMed2005

Neurolytic celiac plexus block: a better alternative to opioid treatment in upper abdominal malignancies: an Indian experience.

The majority of patients with advanced upper abdominal malignancies suffer from moderate to severe pain due to unavailability of morphine in developing world. This study was undertaken to evaluate the role of neurolytic celiac plexus block on pain and quality of life in this patient subpopulation. One hundred consecutive patients receiving opioids for their pain relief were divided in two groups. Group I (control) patients received oral morphine & NSAIDS and group II (study) patients underwent neurolytic celiac plexus block (NCPB) to compare their effects on pain relief, morphine consumption, quality of life (QOL), Karnofsky and performance scores up to one month. NCPB provided statistically significant better pain relief and reduced morphine consumption at one month (P = 0.000). Superior Karnofsky and performance scores also favored NCPB group (P = 0.000); however the difference in overall QOL was not statistically significant (P = 0.24). Patients in oral morphine group had more side effects (94% vs. 58%) as compared to NCPB (P = 0.000). NCPB is an effective tool to reduce opioid requirement and the drug-related adverse effects. It is a rewarding technique, especially when morphine availability and its easy accessibility to the deserving patient is poor.

Adult↗

PubMed1988

Anterior approach to celiac plexus block during interventional biliary procedures.

A fluoroscopically guided anterior approach to celiac plexus block was developed that can be performed on the supine patient during a percutaneous biliary procedure. Unlike posterior blocks, anterior blocks can be performed at any time during the procedure and thus can be reserved for the few patients whose pain does not respond to intravenously administered narcotics. Anterior blocks were performed 18 times in 14 patients; satisfactory visceral anesthesia was achieved in ten of the 18 procedures.

Autonomic Nerve Block↗

PubMed1996

Unilateral celiac plexus block.

Two hundred patients with upper-abdominal malignancy were treated with oral morphine sulfate (OMS) during a 2-year period. Twenty-five of these patients experienced left-sided dragging pain and epigastric discomfort following a few months of adequate pain relief. An increase in the OMS did not relieve the pain. A unilateral left-sided neurolytic celiac plexus block with 20 mL of 50% alcohol was performed using a classical posterior percutaneous approach. This adjuvant technique yielded complete pain relief until death (15-75 days) in 22 patients. All of these patients continued to receive OMS without reduction in dose. Three patients required repeat block after 90 days. This experience documents the value of unilateral celiac plexus block as an adjuvant technique for the management of pain due to upper abdominal cancer.

Abdominal Neoplasms↗

PubMed1989

Steroid celiac plexus block for chronic pancreatitis: results in 16 cases.

Sixteen cases in which celiac plexus block with depot steroid was used to treat chronic pancreatitis pain were reviewed. Only 4 of 16 patients reported pain relief with the procedure. Of the 12 patients who did not obtain relief, narcotic dependence was present in 11 of 12. No patients in the "relief" group were narcotic dependent. Prior pancreatic surgery was present in 9 of the 12 patients without relief and in 1 of 4 patients with relief. It is postulated that refractory chronic pancreatitis pain may be an extreme form of what has been termed "abnormal illness behavior." Furthermore, these results underscore the poor results experienced using neural blockade for the relief of chronic pain when narcotic dependence is present.

Adrenal Cortex Hormones↗

PubMed2004

[The transintervertebral disc approach for educational practice of the neurolytic celiac plexus block].

BACKGROUND: The transintervertebral disc approach was proposed recently for percutaneous neurolytic celiac plexus block (NCPB). Its superior simplicity, reliability, as well as safety potentially overcome the technical hurdles of NCPB that may interfere with the practical use of this validated analgesic intervention for abdominal cancer pain. The present study was conducted to evaluate the effectiveness of the use of this approach in a resident education program for NCPB. METHODS: The clinical results of NCPBs conducted from January 2001 to September 2002 were examined comparing that performed by institutional residents with that by specialized physicians authorized by the Japanese Society of Pain Clinicians. The transintervertebral disc approach was used in all cases. Each resident completed NCPB under close supervision of the specialists. RESULTS: Twenty-four patients received NCPB during the study period. Seven residents randomly completed 12 procedures and 4 specialists did others. The duration of fluoroscopy to complete the procedure was 256+/-109 sec in the resident group and 392+/-194 sec in the specialist group (ns). Significant pain reduction was obtained immediately after NCPB in all patients without any intergroup difference. No critical complication was observed in each group. CONCLUSIONS: The transintervertebral disc approach can be used effectively and safely in educational practice of NCPB for less-trained physicians.

Abdominal Neoplasms↗