In brief
- Upper abdominal visceral pain travels through the celiac plexus, which is why it is felt as a deep, boring ache that radiates to the mid-back.
- The first block uses local anesthetic and confirms your pain travels this pathway. If it works, a neurolytic agent can give relief measured in months.
- Low blood pressure, lightheadedness, and loose stools afterward are expected signs the block reached its target.
- For 72 hours: drink more fluids, rise in stages, and have someone nearby when you stand. Falls are the main reason patients return to the emergency department.
Understanding your diagnosis
Pain arising from the upper abdominal organs, the pancreas, stomach, liver, gallbladder, spleen, and small intestine, does not travel through the ordinary spinal nerves. It travels through sympathetic fibers that converge on a dense network called the celiac plexus, which sits deep in the abdomen directly in front of the spine where the chest meets the abdomen. This is why upper abdominal visceral pain is felt as a deep, boring, poorly localized ache that frequently radiates straight through to the mid-back, and why it responds poorly to treatments aimed at the abdominal wall or the spine.
The treatment
A celiac plexus block places medication directly onto that nerve network, interrupting pain signals from the upper abdominal organs before they reach the spinal cord and brain. The first block is typically performed with local anesthetic: this provides relief and simultaneously confirms that your pain travels this pathway.
If the diagnostic block works and longer relief is the goal, the plexus can then be treated with a neurolytic agent (alcohol or phenol), which produces relief measured in months rather than hours.
Our approach
The procedure is performed face down under live X-ray. Needles are advanced from the back on both sides of the spine to reach the region in front of the vertebral body at the T12–L1 level. Contrast dye is injected first and its spread studied on multiple views to confirm the medication will reach the plexus and is not inside a blood vessel, a critical safety step, since the aorta and its branches lie immediately adjacent.
Before your procedure
Medication holds
Our office will tell you which medications to hold and for how long, following the same blood-thinner guidelines as our other procedures.
Fasting, sedation, and your ride home
- If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
- We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
- Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.
Where to go
Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.
Procedure day
- Performed under live X-ray (fluoroscopy); CT guidance in selected cases.
- IV fluids are given beforehand to blunt the drop in blood pressure that follows the block.
- Local numbing medication with IV sedation for comfort.
- Contrast dye confirms needle position and excludes vascular placement before any medication is given.
- The procedure takes 30 to 45 minutes, followed by a monitored observation period.
Benefits
- Substantial reduction in deep upper abdominal and mid-back pain.
- Meaningful reduction in opioid requirement and opioid-related side effects.
- Improved appetite, activity tolerance, and sleep.
- With neurolysis, relief measured in months rather than hours.
Recovery
- Monitored 1 to 2 hours; blood pressure is checked before discharge.
- You must have a driver.
- Expect temporary loose stools and lightheadedness on standing.
- Local anesthetic relief is immediate; neurolytic relief develops over 1 to 3 days.
Afterward: what to expect
Blood pressure and falls
The most common reason a patient returns to the emergency department after this procedure is a fall caused by low blood pressure. For 72 hours: drink more fluids than usual, get up in stages rather than all at once, and have someone nearby the first several times you stand. If you take blood pressure medication, ask us before your next dose; it is frequently held for a day or two after this block.
- Low blood pressure and lightheadedness. Expected. Blocking these nerves dilates the abdominal blood vessels. Drink fluids generously and change position slowly for 2 to 3 days.
- Diarrhea. Expected, and often welcome in patients who have been constipated on opioids. Usually settles within a few days. Stay hydrated.
- Back soreness. At the needle sites for 2 to 5 days.
- Opioid dose. If your pain drops sharply, your current opioid dose may now be too high and can cause sedation. Do not adjust it yourself; call us.
Activity
Needle site care
Your procedure in one paragraph
You have undergone a celiac plexus block. Under live imaging and with contrast confirmation, medication was placed onto the sympathetic nerve network in front of the spine that carries pain signals from your upper abdominal organs. Interrupting this pathway also produces predictable, expected side effects; these are signs the block reached its target, not complications.
Follow-up schedule
- 1
1 to 2 weeks
Assessment of the degree and duration of relief. If a diagnostic block gave good but temporary relief, neurolysis is discussed at that visit. Record percent relief and how many days it lasted, and bring an updated medication list; opioid doses are frequently reduced at this visit.
Call us right away if you notice
- New weakness, numbness, or heaviness in the legs
- Loss of bowel or bladder control
- Fainting, or lightheadedness that does not improve with fluids and lying flat
- Blood in the urine
- Chest pain or shortness of breath
- Fever above 101.5°F, chills, or drainage at a needle site
This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.