Celiac Plexus Block Techniques in Cancer Pain Management

Cancer-related abdominal pain, particularly from pancreatic and upper gastrointestinal malignancies, remains a major challenge in palliative care. The celiac plexus—a dense network of sympathetic nerves located around the origin of the coeliac trunk—serves as a key relay for visceral nociceptive signals. Interrupting transmission through chemical neurolysis or local anaesthetic blockade can achieve substantial pain relief, reduce opioid requirements and improve quality of life. Techniques include percutaneous approaches under computed tomography or fluoroscopic guidance, endoscopic ultrasound (EUS)-guided injection and minimally invasive surgical denervation. Growing evidence highlights the importance of patient selection, imaging guidance and choice of neurolytic agent or energy source. Comparative studies have examined efficacy, duration of analgesia and safety profiles, while technical refinements aim to minimise complications such as hypotension, diarrhoea or neurological injury. Integration of celiac plexus block into multimodal pain management pathways offers a targeted strategy for refractory visceral pain, underscoring its global significance and adaptability across clinical settings.

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Celiac Plexus Block Techniques in Cancer Pain Management publication trend

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Technical terms

Celiac plexus: A network of sympathetic nerve fibres located anterolateral to the aorta at the T12–L1 level, transmitting visceral pain from upper abdominal organs.

Neurolysis: Destruction of nerve tissue, chemical or thermal, to interrupt pain signal transmission.

Splanchnic nerves: Pre-ganglionic sympathetic fibres conveying nociceptive input from visceral organs to the celiac plexus.

Endoscopic ultrasound (EUS) guidance: Real-time ultrasonographic visualisation via endoscope to target neurolytic injections around the celiac plexus.

Percutaneous approach: Needle insertion through skin under imaging guidance (CT or fluoroscopy) to access the celiac plexus.

Radiofrequency ablation: Application of alternating current via electrode to generate heat and achieve selective neural destruction.

References

1. Interventional Techniques to Management of Cancer-Related Pain: Clinical and Critical Aspects. Cancers (2019).
2. EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial. Journal of Clinical Medicine (2020).
3. Computed Tomography-Guided Percutaneous Radiofrequency Ablation of the Splanchnic Nerves as a Single Treatment for Pain Reduction in Patients with Pancreatic Cancer. Diagnostics (2021).