Celiac Plexus Block in St. Louis

The celiac plexus is a tight bundle of nerves in front of the aorta (the body’s main artery) in the upper belly. Pain signals from the pancreas, liver, gallbladder, stomach and much of the intestine pass through it on the way to the spinal cord. When those organs cause severe pain that will not quit, blocking the plexus turns down the signal that reaches the brain. It is a main treatment for chronic pancreatitis pain.

You lie face down, and we numb the skin and deeper tissue. Using fluoroscopy (live X-ray), we guide needles along the spine bone until the tip sits at the plexus. Contrast dye confirms the right spread before any medicine goes in. A diagnostic block uses local anesthetic only. If that gives good relief, a neurolytic block with alcohol or phenol can make the relief last much longer.

The two clearest uses are pain from chronic pancreatitis and pain from upper belly cancers, mainly pancreatic cancer. In both, the goal is comfort and less need for opioids. Opioids bring their own side effects, and these patients are often already sick.

We watch your blood pressure during and after the procedure. Blocking these sympathetic nerves (the automatic nerves that run blood vessels and the gut) can drop it for a while. More bowel activity is common and expected. Most patients go home the same day. The celiac plexus is one of several sympathetic targets we treat, along with the lumbar sympathetic chain and stellate ganglion.

Pain from the upper belly organs does not travel with the vagus nerve. It rides sympathetic afferent fibers (sensing nerves). These leave the organs and pass through the celiac plexus. Then they run back along the greater, lesser and least splanchnic nerves. They enter the spinal cord between about T5 and T12. All that traffic funnels through one small spot in front of the aorta, at the L1 level of the spine. So one well-placed shot can cut off feeling from the pancreas, liver, gallbladder, stomach and much of the small bowel at once.

The same layout explains the side effects you should expect. The sympathetic fibers in the plexus also keep blood vessels tight and hold back the gut. Block them, and blood pressure drops for a while and the bowels get busier. These are not complications. They prove the block hit its target.

The best-known randomized trial is Wong and colleagues in JAMA in 2004. It tested neurolytic celiac plexus block in pancreatic cancer that could not be removed by surgery. Here are the results straight, not cherry-picked. The block moderately cuts pain. But most patients still need opioids, often at about the same dose. And it does not change survival.

That is a real benefit, and a limited one. The goal is less pain and a slower climb in opioid dose, with fewer of the side effects that climb brings. These patients are often already sick. Anyone who says this procedure will let you stop pain medicine for good is claiming more than the evidence shows.