Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring
CPT4 code
Name of the Procedure:
Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring
Common name(s): Celiac Plexus Block, Celiac Plexus Neurolysis
Summary
A celiac plexus block is a medical procedure used to inject an anesthetic agent directly into the celiac plexus, a network of nerves located near the abdomen. This injection helps alleviate chronic abdominal pain, often using radiologic monitoring for precision.
Purpose
The procedure primarily addresses severe abdominal pain, often associated with conditions like chronic pancreatitis or abdominal cancers. The goal is to provide significant pain relief, which can improve the patient's quality of life.
Indications
- Chronic abdominal pain
- Pancreatic cancer
- Chronic pancreatitis
- Abdominal cancers The procedure is usually recommended for patients who have not found relief through other pain management methods.
Preparation
- Fasting for 6-8 hours before the procedure.
- Adjustment of current medications as advised by the healthcare provider.
- Pre-procedure diagnostic tests like blood tests or imaging studies to assess the area.
Procedure Description
- The patient is positioned, usually lying on their stomach.
- An IV line is started to administer sedation and other medications.
- Imaging guidance (such as fluoroscopy or CT) is used to locate the celiac plexus.
- The skin over the injection site is cleaned and numbed with a local anesthetic.
- A needle is inserted through the skin and directed towards the celiac plexus.
- An anesthetic agent is injected into the celiac plexus, sometimes accompanied by a steroid or neurolytic agent.
- The needle is then removed, and the site is cleaned and bandaged.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
This procedure is usually performed in a hospital or an outpatient clinic with access to imaging technology.
Personnel
- Anesthesiologist or Pain Specialist
- Radiologist (if radiologic monitoring is used)
- Nursing staff
Risks and Complications
Common risks:
- Temporary pain at the injection site
- Lightheadedness or dizziness
Rare risks:
- Infection
- Bleeding
- Nerve damage
- Paralysis (very rare)
Complications can be managed by addressing each issue as it arises, often requiring immediate medical attention.
Benefits
The primary benefit is significant relief from chronic abdominal pain, which can be realized immediately or within a few days after the procedure.
Recovery
- Monitor for a few hours post-procedure to observe for any immediate complications.
- Advised to rest for the remainder of the day.
- Avoid strenuous activities for at least 24 hours.
- Follow-up appointment to assess pain relief and manage any side effects.
Alternatives
- Oral pain medications (opioid and non-opioid)
- Intravenous pain management
- Other nerve block procedures
- Physical therapy
Each alternative has its own set of pros and cons, such as varying degrees of pain relief, side effects, and impact on daily living.
Patient Experience
During the procedure, the patient may feel pressure or a brief stinging sensation when the needle is inserted. Post-procedure, mild discomfort at the injection site is common and usually managed with over-the-counter pain medication. The patient should expect to follow specific care instructions and might experience improved pain relief within a few days.
Pain management and comfort measures will be discussed with the healthcare provider to ensure a smooth recovery process.