1. CELIAC GANG BLOCK PAIN MANAGEMENT/UTMB-GALVESTON DENNIS GRAY, DO, PGY-1

2. ANATOMY

3. DISCLOSURE I HAVE NO FINANCIAL TIES TO DISCLOSE

4. INDICATIONS Acute or chronic pancreatitis Pancreatic cancer Intra abdominal METs disease Diagnostic block: visceral vs. abdominal wall pain Adjunct to surgery

5. NEUROLYTIC AGENTS 0.25-0.5% marcaine + 80mg methylpred 6-10% phenol 50-100% EtOH

6. LANDMARKS

7. INSTRUCTIONS

8. INSERTING SECOND NEEDLE ON THE RIGHT

9. PIERCING THE DIAPHRAGM

10. CONTRAST

11. COMPLICATIONS 0.15-1.0% complication rate Pneumothorax Chylothorax Nerve injury including paralysis Retroperitoneal fibrosis Aterial vasospasm resulting in ASA syndrome Common 96% local pain 44% diarrhea 38% hypotension

12. SUCCESS RATE Eisenberg et al: Adequate-excellent pain relief within first week: 89% 70-90% continued to have pain relief at 3 months

13. REFERENCES Eisenberg E, Carr DB, Chalmers TC. Neurolytic celiac plexus block for treatment of cancer pain: a meta-analysis. Anesth Analg. 1995;80:290-295. Mercadante S, Nicosia F. Celiac plexus block: a reappraisal. Reg Anesth Pain Med. 1998;23:37-48. Ward EM, Rorie DK, Nauss LE, et al.The celiac ganglion in man: normal anatomic variations. Anesth Analg 1979;58:461 Ischia S, Luzzani A, Ischia A, et al. A new approach to the neurolytic block of the coeliac plexus. The transaortic technique. Pain 1983;16:333.