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Celiac Plexus Nerve Block

The celiac plexus is located on both sides of the aorta at approximately the level of the first lumbar vertebra of your spine. Organs supplied with sensation from the celiac plexus include the stomach, liver, gallbladder, pancreas, kidneys, and the gut as far as the transverse colon.

Performed every 2-4 weeks for a total of 3 blocks, Celiac Plexus Nerve Block Therapy is usually administered for:

  • Acute pancreatitis and chronic pancreatitis
  • Pancreatic cancer
  • Crohn’s disease
  • Surgery of the upper abdomen
  • Acute or chronic, non-surgical, abdominal pain

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Ganglion Impar Blockade

The Ganglion Impar represents the termination of the sympathetic chain. It rests anterior to the sacrococcygeal junction. Various techniques are described to block this ganglion, including a bent needle technique that enters at the level of the anococcygeal ligament. However, given the close proximity of the rectal canal to this entry site, the easiest and safest approach is to traverse the sacrococcygeal itself. Injection of contrast agent under fluoroscopy confirms proper needle placement.

The technique can be performed with local anesthetic and steroid for nonmalignant pain conditions, such as coccygodynia, or perirectal pain from tumor involvement. Neurolytic blockade should probably only be performed for malignant pain conditions, and only after a diagnostic block is performed. The advantage of the Ganglion Impar block over other neurolytic procedures for rectal pain is that bowel and bladder function is generally unaffected. However, this should be confirmed first with the local anesthetic block.

Gasserian Ganglion Block

A gasserian ganglion block is a medical procedure in which a small dose of local anesthetics is applied directly to a bundle of nerves that supplies sensation to the face and scalp. This nerve block may bring relief to patients who suffer from trigeminal neuralgia and other syndromes of facial pain, as well as to patients who suffer from pain caused by cancer. In some instances, for instance in those patients who suffer from facial pain due to cancer, a small dose of medication to kill the nerve going to this nerve bundle (the gasserian ganglion) can be used. This is not an option for patients who do not have cancer.

Benefit
Relief is instantaneous, if the pain that is experienced is related only to the nerves which go to the gasserian ganglion. Total duration of pain relief will be six to 12 hours. If a nerve-killing medication is used, maximum relief starts in one to two days, and may last up to three to six months.

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Lumbar Sympathetic Block

The lumbar sympathetic nerves extend from the first to the fifth lumbar (lower back) vertebrae. The lumbar sympathetic nerves run down either side of the spinal column. These nerves supply sensation of the lower extremities.

Benefits:

  • Pain relief and improved healing of skin lesions.
  • Improved blood flow to lower extremities.

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Neurolytic Blocks

A neurolytic block is the injection of alcohol or phenol around a group of nerves to provide long lasting relief (after a previous diagnostic block has provided effective temporary relief). Alcohol or phenol will damage these nerves and will, therefore, grant longer pain alleviating effects than a temporary, local anesthetic drug (e.g., Novocain).

After the nerves have been damaged, they will try to repair themselves over the course of several months to several years, and, eventually, this process or nerve regeneration could result in a patient experiencing greater pain than originally experienced before the neurolytic block. Therefore, these blocks are usually only performed for the treatment of (terminal) cancer pain after other treatment modalities have been tried.

Even though this block is considered permanent, it may not be. It may last for several weeks or months. If the pain returns, this block can be repeated. The procedure is the same as with a temporary local anesthetic block. The only difference is the medication used. This procedure is commonly performed to provide pain relief to patients with pancreatic cancer, ovarian cancer, colon cancer etc.

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Neurolytic Posterior Thoracic Sympathetic Block

This block is indicated for relief of severe pain in sympathetically mediated pain of upper extremities, i.e., reflex sympathetic dystrophy or causalgia. It is also used for chest pain.

With a small amount of alcohol or aqueous phenol being injected in the carefully drawn mark on your upper back, this nerve-killing medicine is injected under CT scanner guidance to make sure it is going into the area necessary for optimal pain relief.

Learn more about the Neorolytic Posterior Thoracic Sympathetic Block procedure

Stellate Ganglion Block

The stellate nerve ganglion is found in the neck area on either side of the trachea. It controls blood flow and pain pain signals to the head, neck and face. A stellate ganglion block is used for treating pain and vascular instability associated with:

  • Reflex sympathetic dystrophy of the head
  • Causalgia
  • Herpes zoster (shingles)
  • Paget’s disease
  • Phantom limb pain
  • Vascular insufficiency, i.e. Raynaud’s disease
  • Scleroderma
  • Thrombosis
  • Shoulder-hand syndrome
  • Hyperhidrosis (excessive sweeting)

Benefits
A reduction in the amount of pain is often felt within 15-20 minutes but can be delayed. The patient will also feel an increase in temperature in the affected arm as the blood supply is increased. It is unusual for pain relief to be permanent after a single stellate ganglion block, but, with repeated blocks on alternate weeks, relief often is prolonged. A course of 5-8 injections is considered normal.

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Superior Hypogastric Plexus Block

The superior hypogastric block has just been recently been introduced for the treatment of either nonmalignant or malignant pelvic pain. The technique was first described by Ricardo Plancarte in 1989.

The plexus lies anterior to the body of the L5 vertebra. It contains postganglionic sympathetic fibers and afferent pain fibers. Innervation of the vagina, rectum, bladder, perineum, vulva, prostate, and uterus arise from this plexus. Therefore, pain felt to originate from any of these structures could theoretically be treated by blockade of this plexus.

The block is performed under CT and fluoroscopic guidance, with the needles placed anterior to the L5-S1 junction. The proximity of the iliac crests necessitates a fairly lateral and slightly cephalad approach. It has been used successfully in the treatment of pelvic pain, and is indicated after oral regimens have failed.

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