18.2 Coeliac Plexus Block

Question 1

a) Describe the anatomy of the coeliac plexus. (35%)

Answer 1

The coeliac plexus is a bilateral structure,
made up of preganglionic
sympathetic fibres from

greater splanchnic (T5–10),
lesser splanchnic (T10–11)
and least splanchnic (T11–12) nerves.

The nerves coalesce anteriorly
to the body of T12 before entering
the abdomen posterior to the
diaphragmatic crura.

It is:
» Retroperitoneal.

> > Anterolateral to the body of L1 bilaterally.

> > Anterior to the aorta and crura of diaphragm.

> > Either side of the origin of the coeliac artery.

> > Medial to the inferior vena cava.

> > Posterior to the stomach and pancreas

Question 2

b) What are the indications for coeliac plexus block? (15%)

Answer 2

The coeliac plexus supplies the
liver, gall bladder, spleen, stomach,
pancreas, kidneys, adrenals,
small intestine and
large intestine proximal to
splenic flexure.

Any cause of intractable pain involving these organs can be managed with coeliac plexus block.

> > Pancreatic cancer pain.

> > Stomach cancer pain.

> > Chronic pancreatitis pain.

> > In theory, coeliac plexus block
can be used for upper abdominal surgery
but is not as there are superior
alternatives without the associated risks.

Question 3

c) List the anatomical approaches used for coeliac plexus block. (10%)

Answer 3

> > Posterior approach.

> > Anterior (retro or trans-crural).

> > Trans-aortic.

> > Transdiscal.

> > Paramedian.

Question 4

d) Which specific complications are associated with coeliac plexus block? (40%)

Answer 4

1&raquo_space; Retroperitoneal bleeding
due to aorta or inferior vena cava
injury by the needle.

2&raquo_space; Intravascular injection into
great vessels
(should be prevented by
checking the needle position
with radio-opaque dye).

3&raquo_space; Paraplegia secondary to phenol
injection into arterial supply of spinal
cord.

4&raquo_space; Direct spinal cord or nerve root damage.

5&raquo_space; Retrocrural spread of phenol,
causing spinal nerve root damage.

6&raquo_space; Intrathecal or epidural injection.

7&raquo_space; Visceral puncture, damage,
abscess or cyst formation
(stomach or kidney).

8&raquo_space; Injection into psoas muscle
with risk of cyst or abscess formation.

9&raquo_space; Pneumothorax.

10&raquo_space; Chylothorax.

11&raquo_space; Thrombosis.

12&raquo_space; Sexual dysfunction
(phenol spread along sympathetic chain).

13» Leg warmth.

14&raquo_space; Hypotension (dilatation of upper abdominal vessels).