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A Comprehensive Review of the Celiac Plexus Block for the Management of Chronic Abdominal Pain

  • Other Pain (AD Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Chronic abdominal pain (CAP) is a significant health problem that can dramatically affect quality of life and survival. Pancreatic cancer is recognized as one of the most painful malignancies with 70–80% suffering from substantial pain, often unresponsive to typical medical management. Celiac plexus neurolysis and celiac plexus block (CPB) can be performed to mitigate pain through direct destruction or blockade of visceral afferent nerves. The objective of this manuscript is to provide a comprehensive review of the CPB as it pertains to CAP with a focus on the associated anatomy, indications, techniques, neurolysis/blocking agents, and complications observed in patients who undergo CPB for the treatment of CAP.

Recent Findings

The CAP is difficult to manage due to lack of precision in diagnosis and limited evidence from available treatments. CAP can arise from both benign and malignant causes. Treatment options include pharmacologic, interventional, and biopsychosocial treatments. Opioid therapy is typically utilized for the treatment of CAP; however, opioid therapy is associated with multiple complications. CPB has successfully been used to treat a variety of conditions resulting in CAP. The majority of the literature specifically related to CPB is surrounding chronic pain associated with pancreatic cancer. The literature shows emerging evidence in managing CAP with CPB, specifically in pancreatic cancer.

Summary

This review provides multiple aspects of CAP and CPB, including anatomy, medical necessity, indications, technical considerations, available evidence, and finally complications related to the management.

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Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Ivan Urits, Mark R. Jones, Vwaire Orhurhu & Ruby Feng

  2. Department of Anesthesiology, Mt. Sinai Medical Center of Florida, Miami Beach, FL, USA

    Jacquelin Peck

  3. Creighton University School of Medicine—Phoenix Regional Campus, Phoenix, AZ, USA

    Devin Corrigan, Ashley Hubble & Megan Andrews

  4. Pain Management Centers of America, Paducah, KY, USA

    Laxmaiah Manchikanti

  5. Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA, USA

    Alan D. Kaye, Rachel J. Kaye & Omar Viswanath

  6. Valley Anesthesiology and Pain Consultants—Envision Physician Services, Phoenix, AZ, USA

    Omar Viswanath

  7. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

  8. Department of Anesthesiology, University of Arizona College of Medicine—Phoenix, Phoenix, AZ, USA

    Omar Viswanath

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  1. Ivan Urits
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  2. Mark R. Jones
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  7. Megan Andrews
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  8. Ruby Feng
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  9. Laxmaiah Manchikanti
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  10. Alan D. Kaye
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Correspondence to Ivan Urits.

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Ivan Urits, Mark R. Jones, Vwaire Orhurhu, Jacquelin Peck, Devin Corrigan, Ashley Hubble, Megan Andrews, Laxmaiah Manchikanti, and Omar Viswanath declare that they have no conflict of interest.

Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck.

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This article is part of the Topical Collection on Other Pain

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Urits, I., Jones, M.R., Orhurhu, V. et al. A Comprehensive Review of the Celiac Plexus Block for the Management of Chronic Abdominal Pain. Curr Pain Headache Rep 24, 42 (2020). https://doi.org/10.1007/s11916-020-00878-4

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