Autonomic insufficiency after neurolytic celiac plexus block

Abstract

Celiac plexus blockade and neurolysis are used to treat pain of the upper abdomen, most commonly the pancreas. The celiac plexus is a collection of visceral, sympathetic, and parasympathetic nerves, and thus blockade results in autonomic effects and analgesia. The most common side effects are transient hypotension, possibly from inhibition of splanchnic vasoconstriction and/or spread of injectate to thoracic sympathetic nerves, and transient diarrhea, from increased peristalsis. Other less common autonomic side effects include chronic diarrhea, sexual dysfunction, and gastroparesis. Liberal intravenous fluids and patient education are recommended for the more common side effects; reports of successful treatment of less common side effects are also presented.