Celiac Plexus Alcoholization (Neurolysis)

Background and indications

Celiac plexus neurolysis is a percutaneous injection of absolute alcohol around the celiac plexus (nerve ganglia located around the aorta at celiac trunk level) to destroy nerve fibers transmitting visceral abdominal pain. It is a palliative treatment for severe pancreatic cancer pain and other upper abdominal cancers (stomach, liver, bile ducts) resistant to conventional analgesics (level III opioids).

Celiac plexus block (local anesthetic injection without alcohol) may be performed beforehand as a diagnostic test to predict neurolysis efficacy.

Pre-procedure assessment

Assessment includes abdominal CT (celiac plexus localization, tumor extension evaluation), pain assessment (VAS, opioid consumption), and coagulation panel.

Procedure

Under local anesthesia and sedation, guided by CT (or ultrasound), two spinal needles (20-22G) are inserted percutaneously via bilateral posterior approach, on either side of the aorta at T12-L1 level. After position verification by contrast injection, local anesthetic is first injected (lidocaine — test block), then 10-20 mL of 95% ethanol is injected on each side. The procedure takes 30-45 minutes.

Results and scientific evidence

Celiac neurolysis offers significant pain relief in 70-90% of cases, with 40-60% opioid consumption reduction. Effect lasts 3-6 months on average. A randomized trial (Wong et al., JAMA, 2004; DOI: 10.1001/jama.291.9.1092) confirmed early neurolysis superiority over optimized analgesic therapy for pancreatic cancer pain: better pain control, lower opioid consumption, and quality of life preservation.

Risks and complications

Orthostatic hypotension (20-40%, transient — due to splanchnic vasodilation), transient diarrhea (20-30%), post-procedural back pain (10-20%), transient inebriation (ethanol absorption: 5-10%). Rare serious complications: paraplegia (< 0.5%, from Adamkiewicz artery involvement — main risk), pneumothorax (< 1%).

Recovery

1 night hospitalization (blood pressure monitoring). Preventive IV hydration. Progressive opioid reduction alongside pain improvement.

Practical information

The procedure is performed as a short inpatient stay. It is performed by an interventional radiologist, in coordination with the oncologist and palliative care team.