Celiac Plexus Injection

The celiac plexus is a group of nerves in the belly. These nerves are near the large blood vessels and the spine. They help control the activity of the stomach, kidneys, upper intestine, pancreas and liver. They also relay pain signals to the nervous system from all of those organs.

Sometimes pain from those areas cannot be treated any other way. An injection can be done to try to reduce the pain. It is a very specialized procedure. It is done by our pain doctors and our GI doctors at the request of other doctors.

Rarely, more than one injection is needed. If so, they are given no closer together than a couple of weeks apart. The first injection is with a numbing medicine and a steroid.

In certain cases, destroying the nerves is needed and other medications are used. The nerve-destroying injections have a higher risk. These are limited to patients with cancer pain.

How Are Celiac Plexus Injections Done?

The injections are done either in Interventional Radiology or the operating room. There are two basic ways to do them.

• When they are done by the pain physician:
• Anesthesia is used to help the patient be comfortable and still for the procedure.
• The patient lays on their stomach for the injection.
• Special cleaning solutions are used.
• X-ray machines and a special x-ray dye are used. This makes sure the needle and medicine are in the exact right place.
• After the medication is injected, the patient will start to wake up and go to the recovery room to finish waking up. They may be watched overnight in the hospital.
• When they are done by the GI physician:
• Anesthesia is used to help the patient be comfortable and still for the procedure.
• The GI doctor uses a scope with an ultrasound probe at the tip (endoscopic ultrasound) to look into the stomach and then use ultrasound to find the celiac plexus.
• A small needle is inserted through the scope, directed into the celiac plexus and the medication is injected.
• After the medication is injected, the patient will start to wake up and go to the recovery room to finish waking up. They may be watched overnight in the hospital.

What Are the Complications of a Celiac Plexus Injection?

There are several possible complications. These typically do not happen. Complications are more likely with the nerve-destroying type of injection. These include:

• Infection
• Bleeding either inside the body or blood in the urine
• Nerve damage or paralysis
• Lung injury
• Diarrhea or lower blood pressure can occur for a little while afterwards. This is not a complication but can be an effect of the numbing medicine on the nerves that usually does not last long or need significant treatment. The anesthesia physician or medical team may give extra fluid to help with these effects.

What Should We Expect after the Injection?

Pain relief happen minutes to hours after the injection. How long the relief lasts is variable. This depends on the type of problem causing the pain.

A repeat injection can be done. Your doctor will talk to you about that option.

When to Call the Doctor

Call your child's doctor if:

• The site of the injection becomes red or swollen
• Your child develops a fever
• Your child has worsening abdominal pain
• There is blood in your child's urine