Name of the Procedure:

Destruction by Neurolytic Agent, with or without Radiologic Monitoring; Celiac Plexus

Summary

This procedure involves using a neurolytic agent to destroy nerves in the celiac plexus, which can help alleviate chronic abdominal pain, particularly from conditions like pancreatic cancer or chronic pancreatitis. The process may be guided by radiologic imaging for precise targeting.

Purpose

The primary purpose of this procedure is to relieve severe abdominal pain by disrupting nerve signals. It is often used for pain management in patients with pancreatic cancer or chronic pancreatitis. The expected outcome is significant pain relief, which can improve a patient's quality of life and reduce dependence on narcotic medications.

Indications

• Severe, intractable abdominal pain due to pancreatic cancer or chronic pancreatitis.
• Patients who have not achieved adequate pain relief from other treatments.
• Individuals who experience significant side effects from high doses of pain medications.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Medication adjustments might be needed, especially if the patient is on blood thinners.
• Diagnostic imaging such as a CT scan or MRI may be conducted beforehand to locate the celiac plexus.

Procedure Description

1. The patient is positioned, usually lying face down.
2. Sedation or local anesthesia is administered to minimize discomfort.
3. Using radiologic imaging like fluoroscopy or ultrasound, a needle is carefully guided to the celiac plexus.
4. Once the needle is in place, a neurolytic agent (such as alcohol or phenol) is injected to destroy the nerve fibers.
5. The needle is then removed, and the injection site is cleaned and bandaged.

Duration

The procedure typically takes about 30 minutes to an hour.

Setting

This procedure is usually performed in a hospital’s radiology department or an outpatient surgical center.

Personnel

• Interventional radiologist or pain management specialist
• Nurses for preparation and aftercare
• Anesthesiologist or nurse anesthetist for sedation or anesthesia

Risks and Complications

• Common: Injection site pain, temporary increase in abdominal pain, nausea, and diarrhea.
• Rare: Bleeding, infection, damage to surrounding organs or structures, paralysis, or allergic reactions to the neurolytic agent.

Benefits

• Significant pain relief, often noticeable within a few days.
• Reduced need for high doses of narcotic pain medications.
• Improved quality of life and physical functioning.

Recovery

• Patients are usually observed for a few hours post-procedure to monitor for any immediate complications.
• Mild soreness at the injection site may occur.
• Most patients can resume normal activities within a day or two.
• Follow-up appointments may be scheduled to assess pain relief and determine if additional treatments are necessary.

Alternatives

• Oral or intravenous pain medications
• Other nerve block techniques
• Surgical options such as nerve root destruction
• Each alternative has its own risks and benefits, and the choice will depend on the individual patient’s condition and response to previous treatments.

Patient Experience

• During the procedure, the patient may feel pressure or minor discomfort, but significant pain is rare due to sedation or local anesthesia.
• Post-procedure, there may be some soreness or a temporary increase in pain.
• Pain relief typically starts within a few days, providing a significant reduction in chronic abdominal pain.