Celiac plexus block: complications

Advanced, Clinical Subspecialties, Pain

Introduction

The celiac plexus is the largest plexus of the sympathetic nervous system. It contains preganglionic sympathetic fibers from greater and lesser splanchnic nerves (emerge from the thoracic sympathetic ganglia, T5 to T12 ) as well as postganglionic sympathetic and preganglionic parasympathetic fibers. It provides sensory innervation and sympathetic outflow to stomach, liver, spleen, pancreas, kidney and GI tract up to splenic flexure. Plexus is located at the level of T12-L2 (usually L1) and lies anterior to aorta in the retroperitoneal space.

Indications

Most common indication is treatment of pain caused by pancreatic cancer. Occasionally used in the treatment of pain from chronic pancreatitis (controversial). Can be used for pain from other GI malignancies from LES to splenic flexure, as well as liver, spleen and kidneys.

Complications

Orthostatic hypotension (most common, can be minimized with fluid hydration) and diarrhea (secondary to blockade of sympathetic fibers). Less common complications include paraplegia (from damage to artery of Adamkiewicz), local anesthetic toxicity, spinal or epidural injection, aortic or vena cava puncture and bleeding, retroperitoeneal hemorrhage, visceral organ injury, and pneumothorax (if needle is placed too cephalad)

  • Anatomical Considerations: preganglionic SNS (greater/lesser splanchnic nerves), postganglionic SNS, preganglionic PNS, sensory
  • Indications: pancreatic cancer (common); sometimes pancreatitis (controversial)
  • Common Side Effects: orthostatic hypotension, diarrhea
  • Rare Side Effects: paraplegia, LA toxicity, spinal/epidural injection, aortic or vena cava puncture, retroperitoeneal hemorrhage, visceral organ injury, pneumothorax

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