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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 42 – Celiac Plexus Block

PERSPECTIVE

Celiac plexus block can be used for many types of intra-abdominal visceral pain syndromes. Its most frequent application is to relieve pain associated with intra-abdominal cancer using a neurolytic solution. Visceral analgesia can also be provided for patients undergoing upper abdominal surgery; combining celiac plexus block with intercostal nerve block provides an unrivaled quality of immediate postoperative analgesia.

Patient Selection.

Most celiac plexus blocks are carried out for cancer pain therapy, and most of the blocks used for cancer pain are performed because of gastric or pancreatic malignancy. The celiac plexus provides innervation to most of the gut from the lower esophagus to the level of the splenic flexure of the colon. Therefore, celiac plexus block may be applicable to a wide variety of patients with an intra-abdominal malignancy.

Pharmacologic Choice.

The celiac plexus is primarily a sympathetic ganglion; thus, low concentrations of local anesthetics are successful in blocking the celiac plexus. For example, 0.5% lidocaine, 0.125% or 0.25% bupivacaine, or 0.1% or 0.2% ropivacaine is adequate. If celiac plexus neurolysis is sought, my choice is 50% alcohol, which is formulated by combining equal volumes of 100% alcohol and 0.25% bupivacaine, to a total volume of 50 mL.

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