| Visceral Pain Procedures |
Abdominal and pelvic pain is mediated by nerves that coalesce with specific ganglia in near the
lumbar spine. The well-defined location of these ganglia allow for interventions designed to
alleviate chronic abdominal or pelvic pain. Abdominal pain may be treated with a celiac plexus
axis intervention. The celiac plexus is located just anterior to the aorta at the L1 vertebral level.
For malignant pain such as pancreatic, stomach or liver cancer, this intervention may consist of
the precise injection of alcohol which destroys the nerves that mediate pain. This is a precise
injection that requires X-ray localization and intense post-procedure monitoring and treatment of
side-effects. Prior to the neurolytic block, a diagnostic block with local anesthetic is usually
performed in order to demonstrate efficacy of the technique and lack of serious complications.
For benign pain conditions that demonstrate short-term improvement with local anesthetic celiac
plexus block, radiofrequency neuroablation of the bilateral greater and lesser splanchnic nerves
may be performed. This splanchnic nerve procedure may be repeated indefinitely, typically at six
to twenty-four month intervals. Pelvic pain is mediated through the superior hypogastric plexus
which is located anterior the spine at the L5-S1 vertebral level. Again, this injection requires
X-ray guidance at an ambulatory surgery center as well as a diagnostic block with local
anesthetic prior to using alcohol for neuroablation. Because this procedure may have negative
side-effects involving bowel and bladder function, the neurolytic procedure is usually limited to
malignancies involving the pelvic organs.
lumbar spine. The well-defined location of these ganglia allow for interventions designed to
alleviate chronic abdominal or pelvic pain. Abdominal pain may be treated with a celiac plexus
axis intervention. The celiac plexus is located just anterior to the aorta at the L1 vertebral level.
For malignant pain such as pancreatic, stomach or liver cancer, this intervention may consist of
the precise injection of alcohol which destroys the nerves that mediate pain. This is a precise
injection that requires X-ray localization and intense post-procedure monitoring and treatment of
side-effects. Prior to the neurolytic block, a diagnostic block with local anesthetic is usually
performed in order to demonstrate efficacy of the technique and lack of serious complications.
For benign pain conditions that demonstrate short-term improvement with local anesthetic celiac
plexus block, radiofrequency neuroablation of the bilateral greater and lesser splanchnic nerves
may be performed. This splanchnic nerve procedure may be repeated indefinitely, typically at six
to twenty-four month intervals. Pelvic pain is mediated through the superior hypogastric plexus
which is located anterior the spine at the L5-S1 vertebral level. Again, this injection requires
X-ray guidance at an ambulatory surgery center as well as a diagnostic block with local
anesthetic prior to using alcohol for neuroablation. Because this procedure may have negative
side-effects involving bowel and bladder function, the neurolytic procedure is usually limited to
malignancies involving the pelvic organs.
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