ISPUB.COM The Internet Journal of Anesthesiology Volume 29 Number 1 1 of 5 Celiac Plexus Block – A Palliative Care For Pancretic Malignancy H Abbas, M Kohli, Murali, S Singh, V Singh Citation H Abbas, M Kohli, Murali, S Singh, V Singh. Celiac Plexus Block – A Palliative Care For Pancretic Malignancy. The Internet Journal of Anesthesiology. 2010 Volume 29 Number 1. Abstract INTRODUCTION The celiac plexus, also known as the solar plexus, is a complex network of nerves (a plexus) located in the abdomen retroperitonially. The celiac plexus is located near where the celiac trunk, superior mesenteric artery, and renal arteries branch from the abdominal aorta. The plexus is formed (in part) by the greater and lesser splanchnic nerves of both sides, and also parts of the right vagus nerve. The celiac plexus proper consists of the celiac ganglia with a network of interconnecting fibers. The aorticorenal ganglia are often considered to be part of the celiac ganglia, and thus, part of the plexus. Celiac ganglia vary from 1 to 5 in number, and also located from T12 to L2 1 . The celiac plexus innervates most of the abdominal viscera, including stomach, liver, biliary tract, pancreas, spleen, kidneys, adrenals, omentum, small bowel, and large bowel to the level of the splenic flexure. Coeliac Plexus block can be performed for pain palliation in patients who have chronic abdominal pain related malignancy. Many ways are available for performing the block; blocks which are performed under image guidance has less complication and good success rate. METHODS AND MATERIALS DESIGN OF STUDY: PROSPECTIVE CASE STUDY After getting approval from the Ethical Committee, Chhatrapati Shahuji Maharaj Medical University, Lucknow, UP, an informed consent was taken from the patients. The procedure was performed in 19 patients referred for treatment of chronic abdominal pain due to pancreatic cancer. A subjective evaluation of the degree of pain relief was obtained by retrospectively reviewing the notes of physicians and nurses. The degree of pain relief was graded from 0 to 4. Blocks that had no effect were graded 0, blocks that provided minimal improvement were graded 1, blocks that clearly reduced pain but did not make the patients comfortable were graded 2, blocks that made the patients comfortable but not pain-free were graded 3, and blocks that rendered the patients entirely free of pain were graded 4. An objective evaluation was also obtained by comparing average daily in-hospital analgesic usage before and after the procedure. TECHNIQUE Before the procedure, in each patient, an intravenous line was established along with ECG, blood pressure, pulse rate and oxygen saturation monitoring. The ultrasonic-guided anterior approach to the coeliac plexus block is used with the patient in the supine position. After setting local cutaneous and subcutaneous anaesthesia, with strict aseptic precautions, a 15-cm-long 25 G-needle is introduced into the epigastrium. The point of the needle is ultrasonographically guided, inserted into the pre-aortic area near the origin of the truncus coeliacus. The position of the needle point is ultrasonographically controlled. After careful aspiration on two levels, 40 ml of absolute alcohol is injected. The spread of the solution is evaluated by ultrasound. If the needle position is correct; a few minutes later the patient has a feeling of warmth in the upper abdominal region. RESULTS Of 19 patients the block was successfully performed in 17 patients. 2 patients refused to give consent. Of the 17 celiac blocks performed, 12 patients had pain relief of grade 3 or 4, three patients had grade 2 pain relief, and two patients had poor pain relief (grade 1 or 0). There was significant reduction in opioid dose was seen in patients with grade 4, 3 and 2 pain relief. There was on an average 81% reduction in