Which of the following is most common complication of celiac plexus block aEUR'
Hypotension The most common complication of celiac plexus is postural hypotension which is largely due to blockade of the lumbar sympathetic chain. Celiac plexus The celiac plexus is situated retroperitoneally in the upper abdomen. It is at the level of T12 and L1 veebrae, anterior to the crura of the diaphragm. It is the main junction for autonomic nerves supplying the upper abdominal organs (Liver, gallbladder, spleen, stomach, pancreas, kidneys, small bowel and 2/3 of the large bowel). The ganglia lie on each side of LI (aoa lying posteriorly, pancreas anteriorly and inferior venacava laterally). The plexus is composed of network of neve fibres from both the sympathetic and parasympathetic systems. Sympathetic supply :? It contains two large ganglia that receive sympathetic fibres from three splanchnic nerves - Greater splanchnic nerves (TIT, to TIT() - Lesser splanchnic nerves (Tio/T,,) - Least splanchnic nerves (Tii/T,2) Parasympathetic supply - From the left and right vagal trunks which pass through the celiax plexus but do not connect there. Technique The block is performed using X-ray screening, intravenous sedation, local anaesthetic infiltration of the superficial layers with the patient in the prone position. Indications of celiac plexus block For releief of pain from nonpelvic intraabdominal organs. Acute pain - may be performed during surgery for postoperative pain relief. Chronic pain - useful for any condition that causes chronic severe upper abdominal visceral pain e.g. chronic pancreatitis (local anaesthetic blocks only). Cancer pain - useful for upper abdominal organ cancer pain and is frequently used for carcinoma of the pancreas Complications of coeliac plexus block:- Ohostatic hypotension :? This is the most common complication of coeliac plexus block. It is more common when retrocrural pr splanchnic technique was used. Treatment includes resting in bed, avoiding changes in position and replacing fluids. Once compensatory vascular reflexes are fully activated this side effect disappears. Backache It results from retroperitoneal hematoma which is formed due to local trauma. Retroperitoneal hemorrhage (rare) Diarrhoea (due to sympathetic block of the bowel, quite common) Abdominal aoic dissection - It occurs due to direct damage by the needle. Paraplegia and transient motor paralysis - It has occurred after celiac plexus block. Intravascular injection Bleeding due to Aoa, inferior venacava.
Hypotension
Retroperiton&al hemorrhage
Pneumothorax
Intravascular injection