CELIAC GANG BLOCK PAIN MANAGEMENT/UTMB-GALVESTON DENNIS GRAY, DO, PGY-1.

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Presentation transcript:

CELIAC GANG BLOCK PAIN MANAGEMENT/UTMB-GALVESTON DENNIS GRAY, DO, PGY-1

ANATOMY

DISCLOSURE I HAVE NO FINANCIAL TIES TO DISCLOSE

INDICATIONS Acute or chronic pancreatitis Pancreatic cancer Intra abdominal METs disease Diagnostic block: visceral vs. abdominal wall pain Adjunct to surgery

NEUROLYTIC AGENTS % marcaine + 80mg methylpred 6-10% phenol % EtOH

LANDMARKS

INSTRUCTIONS

INSERTING SECOND NEEDLE ON THE RIGHT

PIERCING THE DIAPHRAGM

CONTRAST

COMPLICATIONS % complication rate Pneumothorax Chylothorax Nerve injury including paralysis Retroperitoneal fibrosis Aterial vasospasm resulting in ASA syndrome Common 96% local pain 44% diarrhea 38% hypotension

SUCCESS RATE Eisenberg et al: Adequate-excellent pain relief within first week: 89% 70-90% continued to have pain relief at 3 months

REFERENCES Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg. 1995;80: Mercadante S, Nicosia F. Celiac plexus block: a reappraisal. Reg Anesth Pain Med. 1998;23: Ward EM, Rorie DK, Nauss LE, et al.The celiac ganglion in man: normal anatomic variations. Anesth Analg 1979;58:461 Ischia S, Luzzani A, Ischia A, et al. A new approach to the neurolytic block of the coeliac plexus. The transaortic technique. Pain 1983;16:333.