A Comprehensive Review of the Celiac Plexus Block for the Management of Chronic Abdominal Pain
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OTHER PAIN (AD KAYE AND N VADIVELU, SECTION EDITORS)
A Comprehensive Review of the Celiac Plexus Block for the Management of Chronic Abdominal Pain Ivan Urits 1 & Mark R. Jones 1 & Vwaire Orhurhu 1 & Jacquelin Peck 2 & Devin Corrigan 3 & Ashley Hubble 3 & Megan Andrews 3 & Ruby Feng 1 & Laxmaiah Manchikanti 4 & Alan D. Kaye 5 & Rachel J. Kaye 5 & Omar Viswanath 5,6,7,8
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Chronic abdominal pain (CAP) is a significant health problem that can dramatically affect quality of life and survival. Pancreatic cancer is recognized as one of the most painful malignancies with 70–80% suffering from substantial pain, often unresponsive to typical medical management. Celiac plexus neurolysis and celiac plexus block (CPB) can be performed to mitigate pain through direct destruction or blockade of visceral afferent nerves. The objective of this manuscript is to provide a comprehensive review of the CPB as it pertains to CAP with a focus on the associated anatomy, indications, techniques, neurolysis/blocking agents, and complications observed in patients who undergo CPB for the treatment of CAP. Recent Findings The CAP is difficult to manage due to lack of precision in diagnosis and limited evidence from available treatments. CAP can arise from both benign and malignant causes. Treatment options include pharmacologic, interventional, and biopsychosocial treatments. Opioid therapy is typically utilized for the treatment of CAP; however, opioid therapy is associated with multiple complications. CPB has successfully been used to treat a variety of conditions resulting in CAP. The majority of the literature specifically related to CPB is surrounding chronic pain associated with pancreatic cancer. The literature shows emerging evidence in managing CAP with CPB, specifically in pancreatic cancer. Summary This review provides multiple aspects of CAP and CPB, including anatomy, medical necessity, indications, technical considerations, available evidence, and finally complications related to the management. Keywords Chronic abdominal pain . Pancreatic cancer . Celiac plexus block . Neurolytic blocks . Neurolytic agents
Introduction Chronic abdominal pain (CAP) is a significant health problem that can dramatically affect quality of life and survival, leading
to time lost at work, disability, and depression [1–3]. It can arise from both benign and malignant conditions, including pancreatic cancer, inflammatory bowel disease, and chronic pancreatitis [1]. Chronic abdominal pain has a prevalence of
This article is part of the Topical Collection on Other Pain * Ivan Urits [email protected] Mark R. Jones [email protected] Vwaire Orhurhu [email protected] Jacquelin Peck [email protected] Devin Corrigan [email protected] Ashley Hubble [email protected]
Megan Andrews [email protected] Ruby Feng [email protected] Laxmaiah Manchikanti [email protected] Alan D. Kaye [email protected]; [email protected] Rachel
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