Celiac Plexus Block



  • The celiac plexus is a network of ganglia with sympathetic, parasympathetic, and visceral sensory fibers. It is located in the retroperitoneal space anterior to the crura of the diaphragm, surrounds the abdominal aorta and celiac artery, and spans from the lower border of the T12 vertebral body to the upper border of the L2 vertebral body.
  • The celiac plexus receives sympathetic fibers from the splanchnic nerves from T5 to T12, as well as parasympathetic fibers from the vagus nerve.
  • Blockade of the celiac plexus produces analgesia by using medications to interrupt nerve transmission (non-neurolytic) or to permanently injure nerves (neurolytic).
  • There are multiple techniques to perform a celiac plexus block, including retrocrural or anterocrural approaches guided by fluoroscopy, computed tomography (CT), or ultrasound.  There is no strong evidence that one route is superior to another.  Rather, a patient-specific approach must be considered.
Clinical Use: 
  • Indications: chronic non-cancer pain and/or cancer pain in the upper abdomen which may originate from the liver, pancreas, gallbladder, stomach, spleen, kidneys, intestines (small bowel, ascending and proximal transverse colon), adrenal glands, diaphragm, aorta, and/or mesentery and is intractable to standard pharmacologic therapy.
  • The celiac plexus block addresses visceral pain, which arises from stretching, compression, invasion, and/or distention of an organ and tends to cause poorly localized pain that may be described as vague, deep, squeezing, crampy, or colicky.
  • Common medications used in the celiac plexus block include local anesthetics (e.g. ropivacaine), corticosteroids (e.g. dexamethasone), and adjuncts (e.g. clonidine). Neurolytic blocks may include phenol or ethanol.
Special Considerations: 
  • Contraindications: hemodynamic instability, coagulopathy and/or thrombocytopenia that increases the risk of bleeding from an invasive procedure, intra-abdominal infection, bowel obstruction (as unopposed parasympathetic activity will increase gut motility and increase these patients’ risk of bowel perforation).
  • Common side effects of the celiac plexus block include transient pain at the site of injection, orthostatic hypotension (may occur in 1-3% of patients and last for up to 5 days), and diarrhea.¹
  • Rare but serious side effects include lower extremity paralysis, multi-organ failure (due to infarctions caused by vasospasm), injury to kidneys, pneumothorax, abdominal aortic dissection, and retroperitoneal hematoma.1,2

Christiansen S and Erdek M (2018). Neurolytic sympathetic blocks. In HT Benzon, SN Raja, SS Liu, SM Fishman, SP Cohen (Eds.), Essentials of pain medicine (4th ed., pp. 647-653). Elsevier.

Urits I, Jones M, Orhurhu V et al. A comprehensive review of the celiac plexus block for the management of chronic abdominal pain. Current Pain and Headache Reports. 2020;24:42.

Zhong M, Yu Z, Zeng J et al. Celiac plexus block for treatment of pain associated with pancreatic cancer: A meta-analysis. Pain Practice. 2013;14:43-51.