Celiac Plexus
Block & Neurolysis

Indications

• Pancreatic cancer pain — neurolysis (alcohol), durable effect
• Chronic pancreatitis — block (steroid), temporary relief
• Upper abdominal malignancies — gastric, hepatobiliary, adrenal
• Opioid-refractory upper abdominal pain
• Opioid dose reduction — to minimize systemic side effects
• Performed early in pancreatic cancer — better outcomes before cachexia
• EUS-guided CPB — preferred when endoscopist available
• CT-guided — standard IR approach; posterior retrocrural or anterocrural

Technique Overview

• Target — celiac plexus at T12-L1, anterior to aorta at celiac axis
• Retrocrural approach — posterior to diaphragmatic crura
• Anterocrural — anterior to crura; higher success, more risk
• Bilateral needles — L1 level, just lateral to aorta
• CT guidance — confirm needle position, assess spread
• Test dose — contrast injection confirms periaortic spread
• Neurolysis — 10–15 mL 95% ethanol per side with local anesthetic
• Block — 10 mL bupivacaine + methylprednisolone per side

Outcomes and Complications

• Pain reduction — 70–90% of pancreatic cancer patients respond
• Duration — weeks to months; may require repeat in chronic pancreatitis
• Orthostatic hypotension — splanchnic vasodilation; IV hydration pre-procedure
• Diarrhea — sympathetic blockade, 40–60%; usually self-limited
• Paraplegia — rare (<1 in 700); anterior spinal artery injury
• Retroperitoneal hematoma — aortic puncture; CT post-procedure
• Alcohol injection pain — transient burning during injection
• Infection — retroperitoneal abscess; rare with sterile technique

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