Splanchnic Nerve block

Performed by Top Pain Management Doctors in San Antonio, Texas


A nerve block is a treatment option for pain that is not treatable with medications or other therapies. The procedure involves injecting anesthetic medicine into a group of nerves to numb the pain. The splanchnic nerves travel from the spinal cord to the celiac plexus, which innervates the abdomen. The splanchnic nerves communicate pain signals from the abdominal organs (stomach, small intestine, kidneys, gall bladder, liver, pancreas, spleen and adrenal gland) to the spinal cord where they continue on to the brain. Patients suffering from cancer-related abdominal pain, chronic pancreatitis or chronic abdominal pain receive pain relief from a splanchnic nerve block.

Anatomy

The three splanchnic nerves (greater, minor and least) emerge from the thoracic spinal nerves at the eleventh and twelfth thoracic vertebrae at a point just above the arch of the diaphragm in the retro peritoneum. These nerves terminate in the celiac plexus, which is located in the abdomen close to the aorta. In turn, the celiac plexus communicates with the abdominal organs from the level of the lower esophagus to the colon.

Procedure

The patient is instructed to lie on the stomach and local anesthesia is injected to numb the skin and make the procedure more comfortable for the patient. Intravenous sedation may be administered to allow the patient to be calm and still during the procedure. Initially, a temporary nerve block in the form of anesthetic will be administered to the splanchnic nerves to assess how affective the treatment is in relieving the patient’s pain. A needle is inserted bilaterally to the eleventh thoracic vertebra, and once proper position has been documented by fluoroscopy (X-ray with dye for visualization) anesthetic is injected to the nerves. The local anesthetic numbs the splanchnic nerves and inhibits the transmission of pain messages to the brain. The procedure takes less than 30 minutes. A successful splanchnic nerve block is evidenced by profound pain relief.

Patients who have documented pain relief from a local anesthetic block injected into the splanchnic nerves are candidates for a more permanent nerve block. Injecting alcohol to the splanchnic nerves impairs their ability to conduct pain messages, and may provide two or three months of pain relief. However, this treatment may pose a risk to nearby nerves, blood vessels and tissues. Radiofrequency is another nerve block option that is safe and effective. During this procedure, needles that conduct electric current are inserted to the eleventh and twelfth thoracic vertebrae bilaterally, using fluoroscopy to find the correct position. Local anesthetic is injected, and then radiofrequency ablation of the nerves is administered to the splanchnic nerves. This procedure affects only a specific area, with no negative consequences to surrounding nerves and tissues. It also results in long-term pain relief.

Benefits

After receiving a splanchnic nerve block, many patients with chronic, unmanageable abdominal pain related to cancer or inflammation report profound pain relief. This enables these patients to have an improved quality of life, leading a more physically active and independent lifestyle. A splanchnic nerve block may reduce the patient’s alliance on opioid medications, freeing them from unwanted side effects such as drowsiness, constipation, confusion, etc.

Risks

Splanchnic nerve block is a minimally invasive, low-risk procedure. Rarely, patients may experience complications such as:

  • Infection at the injection site
  • Misplacement of the needle resulting in bleeding or pneumothorax
  • Hypotension (low blood pressure)
  • Increase in bowel movements or diarrhea
  • Allergic reaction to the medication

Symptoms usually resolve within three days.

Outcomes

Splanchnic nerve blocks are effective in relieving chronic abdominal pain of the liver, gallbladder, pancreas, stomach, small intestine and kidneys. Many patients are unable to obtain pain relief from oral opioid medications or cannot tolerate the drug side effects. The splanchnic nerve block is a minimally invasive, low-risk, outpatient procedure capable of relieving chronic pain resulting from cancer and pancreatitis. Pain relief may be short-lived for some patients, while others may benefit from a splanchnic nerve block for years. Those who experience a successful nerve block may continue to get relief from repeat treatments at a low risk of complications.

References

Dimitris Papadopoulos M.D. (January 24, 2012). Splanchnic Nerves Block/Lesion. Retrieved from http://www.e-algos.com/splanchnic-nerves-block-lesion/

The Spine & Pain Institute of New York. Celiac Plexus Block. Retrieved from http://spinepainny.com/celiac-plexus.php

Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D. Retrieved from http://arizonapain.com/pain-center/pain-treatments/celiac-plexus-block/