Celiac Plexus or Retrocrural Splanchnic Nerve Blocks Effective for Non-Cancer-Related Abdominal Pain

Noncancer-related abdominal pain was effectively managed with computed tomography (CT)-guided celiac plexus or retrocrural splanchnic nerve (CP/RSN) blocks according to the results of a retrospective review of clinical records, which were published in Academic Radiology.

Patients (N=72) who underwent CP/RSN blocks at the Mayo Clinic in Arizona for abdominal pain between 2011 and 2020 were assessed for clinical outcomes.

Patients had a mean age of 43 (range, 19-78) years, 60% were women, 68% had type 2 diabetes, 74% had bilateral pain, 75% underwent a temporary block, and 61% a celiac block.

Most patients (n=40) underwent CP/RSN blocks for noncancer pain. All procedures were technically successful.

More than half of patients (67%) had effective pain relief following their CP/RSN block lasting a mean of 51 (range, 2-700) days. Among the 24 ineffective procedures, pain was relieved for an average of 1 (range, 0-8) day(s).

Stratified by celiac and splanchnic blocks, effective pain relief was achieved for postural orthostatic tachycardia syndrome or dysautonomia (67% and 82%), pancreatitis (86% and not applicable), chronic postsurgical pain (67% and 50%), and median arcuate ligament syndrome (60% and 80%), respectively.

Among effective permanent blocks, pain relief persisted for an average of 111 (range, 14-390) days. More celiac permanent blocks were effective (62%) than splanchnic blocks (20%).

For the temporary blocks, 72% were effective with an average relief of 37 (range, 2-700) days. Fewer celiac blocks were effective (65%) than splanchnic blocks (83%).

Among patients who had underwent a previous block, fewer permanent procedures were effective (40%) but more temporary blocks were (88%).

Adverse effects of CP/RSN blocks included diarrhea (13%), pain (4%), vomiting (4%), nausea (3%), and abdominal distension (3%). Chronic diarrhea persisted for 4 and 6.5 months for 2 patients.

This study was limited by relying on patient-reported pain relief instead of using validated pain assessment tools.

The study authors concluded CT-guided CP/RSN blocks were effective at managing pain among most patients with noncancer-related abdominal pain.

Reference

Liou H, Kong MJ, Alzubaidi SJ, Knuttinen MG, Patel IJ, Kriegshauser JS. Single-center review of celiac plexus/retrocrural splanchnic nerve block for non-cancer related pain. Acad Radiol. Published online April 8, 2021. doi:10.1016/j.acra.2021.03.005