Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CELIAC PLEXUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

Abdominal pain and alcohol celiac plexus nerve block.

Alcohol celiac plexus nerve blocks were done in 100 patients, of whome 97 had intractable abdominal pain from cancer. In most cases, an initial diagnositc block with bupivacaine was followed by the therapeutic block performed by injecting 50 ml of 50 percent ethyl alcohol. Good to excellent pain relief occurred in 94 percent of patients. Fourteen blocks were repeated for recurrent pain. Life duration ranged from 2 days to 14 months after the block. Complications and side effects were infrequently seen but did include a 10 percent incidence of postural hypotension and 1 case of partial leg paralysis. This block is remarkably safe as well as effective and should be employed more frequently.

Abdomen↗
PubMed1999

A prospective randomized comparison of endoscopic ultrasound- and computed tomography-guided celiac plexus block for managing chronic pancreatitis pain.

OBJECTIVE: Computed tomography (CT)-guided celiac plexus neurolysis has been used for controlling the chronic abdominal pain associated with intra-abdominal malignancy and chronic pancreatitis. Endoscopic ultrasound (EUS)-guided celiac plexus neurolysis has been reported to have some success in controlling pain from pancreatic cancer. The aim of this study is to assess the efficacy of EUS-guided celiac plexus block versus CT-guided celiac plexus block for controlling the chronic abdominal pain associated with chronic pancreatitis. METHODS: Patients enrolled were randomly assigned to EUS-guided or CT-guided celiac plexus block. Pain scores were determined pre- and postceliac block for both techniques. Follow-up was obtained by a nurse at 1 day post-block, then weekly thereafter for 24 wk. Patients also rated overall experience with these procedures. The EUS celiac block was performed with a 22-gauge sterile needle inserted into the celiac region with guidance of real-time linear array endosonography followed by injection of 10 ml of bupivacaine (0.75%) and 3 ml (40 mg) of triamcinolone on both sides of the celiac area. RESULTS: Twenty-two consecutive patients (10 men, 12 women), were ultimately enrolled in this study between 7/1/95 and 12/30/95; four patients were excluded for protocol violations. We performed EUS-guided celiac block in 10 patients and CT-guided celiac block in eight. A significant improvement in pain scores with reduction in pain medication usage occurred in 50% (five of 10) of patients having the EUS block. The mean postprocedure follow-up was 15 weeks (range: 8-24 wk). Persistent benefit was experienced by 40% of patients at 8 wk and by 30% at 24 wk. In the patients with CT block, however, only 25% (two of eight) had relief. The mean follow-up was 4 wk (range: 2-6 wk). Only 12% (one of eight) had some relief at 12 wk of follow-up. There were no complications. EUS-guided celiac block was the preferred technique among patients who experienced both techniques. A cost comparison between both celiac block techniques shows EUS to be less costly than CT. CONCLUSIONS: EUS-guided celiac block provided more persistent pain relief than CT-guided block and was the preferred technique among the subjects studied. EUS-guided celiac block appears to be a safe, effective, and less costly method for controlling the abdominal pain that can accompany chronic pancreatitis in some patients.

Abdominal Pain↗
PubMed2001

Increasing the efficacy of a celiac plexus block in patients with severe pancreatic cancer pain.

The purpose of this study was to evaluate the technical possibilities of placing a catheter near the celiac plexus for performance of a celiac plexus block, and to study the efficacy of repeated neurolytic celiac plexus blocks with alcohol in patients with advanced pancreatic cancer pain resistant to opioid treatment. In 12 patients, a neurolytic celiac plexus block with alcohol, administered via an indwelling celiac catheter, was performed. To evaluate the efficacy, visual analog scale scores were recorded every day. Quality of life scores were registered before and 4 weeks following the procedure. Alterations in opioid consumption, and the time between the diagnosis of pancreatic cancer and the performance of the block, were registered. All patients were followed until they died. Two patients remained without pain after the first neurolytic celiac plexus block. In all other patients a second block was administered which provided only temporary relief. Additional intermittent administration of bupivacaine through the catheter was necessary to provide adequate pain relief in these patients. Quality of life increased significantly during the treatment. Opioid consumption decreased significantly in all patients. Our study indicates that a neurolytic celiac plexus blockade with alcohol results in a significant but short-lasting analgesic effect. The use of a celiac catheter improves the long-term management of pancreatic cancer pain.

Autonomic Nerve Block↗
PubMedDate not supplied

Retroperitoneal abscess after neurolytic celiac plexus block from the anterior approach.

BACKGROUND AND OBJECTIVES: The anterior approach for celiac plexus block has the potential risks of infection, hemorrhage, and fistula formation. We report a case of a patient who developed a retroperitoneal abscess with the formation of a vascular-enteric fistula after a neurolytic celiac plexus block from the anterior approach. CASE REPORT: A 60-year-old female with a history of pain secondary to chronic idiopathic calcifying pancreatitis (VAS 7-8) underwent a subtotal resection of the head of the pancreas with an end-to-side pancreatojejunostomy using a Roux-en-Y loop. Pain continued secondary to chronic pancreatitis. Because of intolerance (vomiting and constipation) of morphine and transdermal fentanyl over a 2-month period, it was decided to perform a neurolytic celiac plexus block using the anterior approach with ultrasound guidance. The patient's pain was completely relieved, enabling withdrawal of oral analgesics. Pain reappeared after 2 years, and the same technique was repeated. Ten days later, she was admitted with diabetic ketoacidosis and lower gastrointestinal bleeding. Computed tomography showed a left paravertebral retroperitoneal abscess; arteriography suggested a fistula between the mesenteric vein and the jejunum. Urgent surgery was undertaken, revealing a leak of the pancreatojejunostomy and a large abscess around the celiac plexus. A distal pancreatectomy and partial resection of the Roux-en-Y loop was performed. The patient was discharged 1 month later in good clinical condition. Because of recurrent pain, she has required repeated neurolytic celiac plexus blocks via a posterior approach without complications. CONCLUSION: The posterior approach for neurolytic celiac plexus block should be considered in particular in patients with previous pancreatic surgery.

Abdominal Abscess↗
PubMed1984

[Ultrastructure of celiac plexus nodes in the dog].

A normal structure of the celiac plexus nodes has been studied in 12 mature dogs. As demonstrate the results of the investigation, gangliocytes of the celiac plexus are characterized with a well developed granular cytoplasmic reticulum and a large number of Golgi complexes. In perikaryon of the gangliocytes, an essential number of mitochondria, microtubules, free ribosomes and polysomes, lysosomes, multivesicular bodies, agranular and granular vesicles and neurofilaments are found. The gangliocyte has one nucleus which occupies about 1/3 of the whole area of the cell. The nucleus is rich in chromatin. The nucleolus makes about 1/5 of the whole area of the nucleus and is intensively rich in heterochromatin. In the celiac plexus nodes amyelinated neural fibers predominate. Dendrites in the gangliocytes differ from axons by a higher electron density of their matrix and contain the same organells that does the perikaryon of the gangliocyte. Rather complex glyoneuronal interrelations are observed in the canine celiac plexus nodes. Synapses are revealed in all ganglionar zones. The axodendritic synaptic contacts predominate over the axosomatic ones.

Animals↗
PubMed1992

[The function of the celiac plexus in patients with duodenal ulcers].

The authors suggest a method of transgastric electrostimulation of the celiac plexus which allows its functional condition to be appraised. The method consists in electrostimulation of the celiac plexus through a gastroscope and registration of the effect by dynamic rheohepatography. It was approbated in 23 patients with duodenal ulcers, postvagotomy syndromes, and gastroduodenitis. Analysis of the curves reveals two types of pathological responses characterizing increased and diminished reactivity of the celiac plexus. Diminished reactivity of the celiac plexus is characteristic of celiac ganglioneuritis with fibrosis and dystrophy of the celiac ganglia. Increased or diminished reactivity of the celiac plexus is registered in patients with duodenal ulcers, depending on the presence of complications.

Celiac Plexus↗
PubMedDate not supplied

A case of reversible paraparesis following celiac plexus block.

BACKGROUND AND OBJECTIVES: Permanent and acute reversible paraplegia following celiac plexus block (CPB) have been reported. We report a case of prolonged reversible paraparesis after alcohol celiac plexus block. CASE REPORT: A 72-year-old man with primary multicentric pancreatic tumor and multiple hepatic metastases underwent alcohol celiac plexus neurolysis for severe abdominal pain radiating to the back. The patient had complete pain relief after the block but developed paresthesia of the left leg, which then spread to the right leg. Subsequently, loss of flexion and extension of the muscles supplying the left hip, knee, and foot developed. Deep tendon reflexes were brisk on the left compared to the right, and both plantar reflexes gave flexor responses. Magnetic resonance imaging and myelography were normal. Motor-evoked potential recordings showed a spinal cord lesion with involvement of the pyramidal and spinothalamic tracts. Somatosensory-evoked potentials indicated a relative sparing of dorsal column pathways. Physiotherapy was started, the sensory changes gradually subsided, and the patient was discharged 30 days after the block with clinically insignificant neurological deficit. CONCLUSIONS: Paraparesis following alcohol celiac plexus block may be reversible over an extended period of time.

Aged↗
PubMed1991

[Status of the celiac plexus in patients with extravasal compression of the celiac trunk and its role in the etiology of pain syndrome].

The technique and results of surgical treatment of 109 patients with extravasal compression of the celiac trunk (ECCT), which in 77 patients was combined with a duodenal ulcer, are described. In the celiac plexus of the patients with ECCT, the inflammatory-sclerotic changes of a different degree of pronouncement were revealed. It was established that periarterial sympathectomy of the celiac artery and its branches had an essential effect on the state of gastric functions. In patients after isolated transection of a median phrenic ligament, the changes in gastric functions were not sharply pronounced.

Abdominal Pain↗
PubMed1992

[Role of resection of the celiac plexus in the analgesic treatment of pancreatic cancers].

The aim of this study was to evaluate the pain relief related to resection of the celiac plexus in pancreatic carcinoma. This technique was attempted in 26 consecutive patients and performed in 23 (feasibility: 88%), whose mean age was 64 years. Before surgery, patients were divided into two groups: patients not treated by narcotic analgesics (group 1, n = 10) and patients treated by narcotic analgesics (group II, n = 13). Surgery was indicated in 22 patients for pancreatic resection or by-pass, and in 1 patient for pain relief after an unsuccessful per-cutaneous celiac plexus block. Resection of the celiac plexus was always performed via a trans-peritoneal approach, after mobilization of the head of the pancreas and the duodenum. Only the right half of the celiac plexus was resected in 4 patients (17%) due to technical difficulties. Pathologic examination was performed in 16 patients (8 patients from each group) and neoplastic involvement was observed only in 3 patients of group II. There was no operative death. Two complications related to this method occurred (9%). One patient developed a chylous ascites and was treated conservatively. In a second patient, an occlusion of the celiac trunk was complicated by infarction of the spleen and of the left lobe of the liver; this patient was reoperated and his subsequent post-operative course was uneventful. In group I, eight patients (80%) did not require narcotic analgesics after resection of the celiac plexus. Two failures occurred, one immediately after surgery and one delayed. In group II, seven patients (53%) did not require narcotic analgesics; 6 of these 7 patients died. Six failures occurred, 4 early after surgery and 2 delayed. Three of the 4 early failures occurred in patients who underwent resection of the right half of the celiac plexus. The authors concluded that resection of the celiac plexus seems to be an effective pain treatment in pancreatic carcinoma. However, resection must be bilateral to provide analgesia. Specific morbidity of this technique may lead to the use of non-surgical methods if surgery is not indicated for pancreatic resection or by-pass.

Adenocarcinoma↗
PubMedDate not supplied

One needle transcrural celiac plexus block. Single shot or continuous technique, or both.

BACKGROUND AND OBJECTIVES: The purpose of the study was to establish a one needle transcrural technique for the celiac plexus block in the lateral position. Contrary to the conventional prone bilateral approach, the lateral position with a cushion under the flank is better tolerated and makes bony landmarks more accessible. Unilateral needle placement reduces the morbidity of the technique and should also enable one to apply single administration or continuous blocks, or both. METHODS: Primary anatomic studies on 20 corpses were performed. The needles were inserted anteromedially, on the left side, 4-6 cm lateral from the spinous process of L1 vertebral body, to reach the celiac plexus area at the level of the celiac axis, and 30 mL of methylene blue was injected. Autopsy revealed the needle tips placed preaortic or paraaortic and methylene blue covered the celiac plexus area bilaterally with a predominance on the left side. With the same technique, an epidural catheter was inserted via the needle and injected methylene blue covered the area of the plexus as well. RESULTS: This technique was further employed in the pain clinic, on 35 consecutive patients with pancreatic or gastric carcinoma, for diagnostic celiac plexus block and subsequent neurolysis for pain relief (70 celiac plexus blocks). The technique was employed in the first 10 cases with the aid of computed tomography and subsequently using only fluoroscopy. The effects were comparable to the other techniques of blocking the celiac plexus. CONCLUSIONS: Clinical results proved that the unilateral, transcrural technique in a lateral position is simple, safe, and gives a reliable celiac plexus block or neurolysis effects under fluoroscopy, or both, comparable to the results where computed tomography was used. The possibility of continuous block makes this technique useful in clinical practice.

Celiac Plexus↗
PubMed2002

Neurohistopathologic findings after a neurolytic celiac plexus block with alcohol in patients with pancreatic cancer pain.

Pancreatic cancer has a very poor prognosis resulting in the death of 98% of patients. Pain may be severe and difficult to treat. Management of pain includes chemotherapy, radiotherapy, pharmacologic treatment, and neurolytic celiac plexus block. Recent reviews of the efficacy of neurolytic celiac plexus block however, have reached conflicting conclusions. In this paper, we present two patients with severe pancreatic cancer pain resistant to pharmacologic treatment. Analgesic effect following repeated neurolytic celiac plexus blocks with alcohol was limited in time. Post-mortem neurohistopathologic examination of the celiac plexus revealed an abnormal celiac architecture with a combination of abnormal neurons with vacuolization and normal looking neuronal structures (ganglionic structures and nerve fibers) embedded in fibrotic hyalinized tissue. Our results show that a neurolytic celiac plexus block with alcohol is capable of partially destroying the celiac plexus. These findings may explain the significant but short-lasting analgesic effect following neurolytic celiac plexus block with alcohol.

Autonomic Nerve Block↗
PubMedDate not supplied

Paraplegia following intraoperative celiac plexus injection.

The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.

Adult↗
PubMedDate not supplied

Celiac plexus block. Retrocrural computed tomographic anatomy in patients with and without pancreatic cancer.

BACKGROUND AND OBJECTIVES: Neurolytic celiac plexus block is often performed for analgesia from pancreatic cancer, but it is not known if the cancer alters the anatomy relevant to the successful performance of retrocrural celiac plexus block. METHODS: Abdominal computed tomographic scans were used to simulate retrocrural celiac plexus block in patients with and without pancreatic cancer. RESULTS: Simulated right-sided needle placement in the retrocrural space was more likely to fail in patients with pancreatic cancer than in patients without cancer. Such predicted failure often occurred when the cross-sectional area of the right retrocrural space was less than 1.0 cm2. CONCLUSIONS: The predicted success of stimulated retrocrural celiac plexus block differed between patients with and without pancreatic cancer. These findings have implications for the performance of celiac plexus block.

Adult↗
PubMed1990

Celiac plexus neurolysis with the modified transaortic approach.

Celiac plexus block with alcohol was performed to relieve pain in 124 patients with abdominal malignancies. A transaortic technique was employed in which a single needle was advanced from a left posterior paramedian approach through the aorta to deposit anesthetic agent directly onto the celiac plexus. Ninety-one percent of patients experienced marked pain relief. No major hemorrhagic or neurologic complications were encountered. The transaortic method of celiac block is as effective as, easier to perform, and may be safer than the classic two-needle technique.

Aged↗
PubMed1986

Acetaldehyde syndrome after celiac plexus alcohol block.

In the course of celiac plexus alcohol block, facial flushing, palpitations, and hypotension are occasionally incurred in some patients. We hypothesized that the phenomenon represents acetaldehyde syndrome, not response to increased blood levels of ethanol as might be supposed. In order to prove our hypothesis, we selected five patients scheduled to undergo celiac plexus alcohol block, and, with their consent, we measured blood concentration of ethanol and acetaldehyde before and for 6 hr after the block. We also determined the phenotypes of aldehyde dehydrogenase (ALDH) in their hair roots. We found that "flushers" are found exclusively among subjects without ALDH I, and that their blood levels of acetaldehyde were significantly higher than those of "non-flushers" within 10 min after the block. The flushers also gave histories of facial flushing after ingestion of small amounts of ethanol. On the basis of such histories one can anticipate whether acetaldehyde syndrome is likely or unlikely to accompany the block.

Acetaldehyde↗
PubMed1997

Endosonography-guided celiac plexus neurolysis.

Endosonography-guided celiac plexus neurolysis is a new technique that permits chemical splanchnicectomy in patients with abdominal pain due to malignancy. The procedure can be performed on an outpatient basis in individuals undergoing endosonographic examinations for staging and biopsy purposes.

Abdominal Neoplasms↗
PubMed1999

[Neurolytic block of the celiac plexus and splanchnic nerves with computed tomography. The experience in 150 cases and an optimization of the technic].

INTRODUCTION: CT-guided celiac plexus and splanchnic nerve neurolytic blocks are procedures for pain relief in patients with upper abdominal malignancies. In the last 20 years, the technique has been modified by the introduction of CT guidance providing improved precision and safety. We report our personal experience and provide suggestions for technique optimization. MATERIALS AND METHODS: In 1991-1998 we performed 150 celiac plexus and/or splanchnic nerve neurolytic blocks with ethyl alcohol in 144 cancer patients; the procedure was repeated in 6 patients. In 69% of cases the patient had a pancreatic lesion. We prefer an anterior approach with very thin needles (22 Gauge). The sites of alcohol injection (celiac plexus, splanchnic nerves or both) are chosen after evaluation of anatomy by preliminary CT scans, or during the procedure, depending on alcohol (mixed with a contrast agent) spread. RESULTS: The mean duration of the procedure ranged 50 min (1991) to 22 min (1998). 48 hours after the block we obtained major pain relief in 79% of cases. After 15 days, 21% of patients had no pain (drugs: none), 29% had mild pain (therapy: non-steroid anti-inflammatory drugs), 32% had marked pain (therapy: non-steroid anti-inflammatory drugs and, occasionally, opioids), 18% had severe pain (only opioid therapy). Pain relief was more frequent in splanchnic nerve blocks. DISCUSSION: Our experience confirms that neurolytic celiac plexus and/or splanchnic nerve block is a good choice in the treatment of upper abdominal cancer pain. We would also like to add that: 1) celiac plexus block with CT guidance (with the needle tip positioned anterior to aorta) and splanchnic nerve block (with the needle tip positioned posterior to diaphragmatic crura) are no longer two separated techniques, but they can be chosen and combined according to patients needs. 2) All procedures can be performed with anterior approach, in supine position, with a single thin needle, allowing to reach the target without any complication, even after puncturing stomach, liver, bowel, pancreas or aorta. 3) With CT guidance, even splanchnic nerve neurolysis is a low-risk technique, which should be adopted in all cases of insufficient alcohol spread in the celiac plexus. 4) When the operators are skilled and experienced enough, the time required for the block can be significantly decreased to nearly the time required for US-guided or fluoroscopic-guided procedures.

Autonomic Nerve Block↗
PubMed2001

[Analgesic effect of neurolytic celiac plexus block guided by ultrasonography in advanced malignancies].

OBJECTIVE: To investigate the analgesic effect of celiac plexus block with anhydrous alcohol in patients suffering form advanced abdominal malignancies. METHODS: Ultrasonographically demonstrated and guided, 20 to 50 ml of anhydrous alcohol is injected into the celiac plexus and superior mesenteric plexus by fine needle of 22G. The injecting angle between the needle and the aorta is 20 to 30 degree. The injecting fields mainly located around the celiac plexus and the dorsal part of tumor are also injected. Sometimes if the tumor is rather large, an appropriate amount of alcohol was injected inside too. RESULTS: Twenty-eight cases of advanced abdominal malignancies were treated, among whom 96.4% achieved analgesic effect of different degree, 53.6% (15 cases) achieved the period of pain relief over three days, and 42.8% (12 cases) achieved partial relief. The analgesic effect is correlated with the amount of alcohol injected, i.e. no complete relief was observed in the four patients who received less than 12 ml, while two out of six could get transient complete relief in those who received 15 to 28 ml. In the group of 30 to 50 ml, 72.2% (13 cases) could get complete pain relief. Nine cases with big tumor received injection in side the tumor, with six tumors resulting in shrinkage or necrosis, significant pain relief also achieved in these cases. Complications occurred in nine cases (32.1%), with four cases of postural hypotension, two cases of vomiting, two cases of hiccup and one case of diarrhea. CONCLUSION: Neurolytic celiac plexus block guided by ultrasonography is a safe and effective modality in the management of intractable pain resulted from advanced abdominal malignancies.

Abdominal Neoplasms↗