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8/9/2019 Common Neurolytic Blocks for Pain Management
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NEUROLYTIC BLOCKS
Involves blocking of symp!"e!ic
c"in ! vrio#s levels
$reven!s !rnsmission of pin
imp#lses from !"e !rge! orgns !o !"e brin
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NEUROLYTIC BLOCKS
%"e nerves "ve !"e !en&ency !o
regener!e
Blocking effec! is !emporry
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DURATION
' mon!"s !o () mon!"s
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COMMON NEUROLYTIC BLOCKS
S!ell!e gnglion block %"orcic symp!"e!ic c"in block
Coelic ple*#s block
L#mbr symp!"e!ic block
S#perior "ypogs!ric block
Gnglion impr block
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STELLATE GANGLION
BLOCKStellate ganglion formed by union of
Mi&&le cervicl
Lo+er cervicl
,irs! !"orcic segmen!
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STELLATE GANGLION
BLOCKPain relief to structures of
Neck ,ce
-pper limb -pper !"or* #p!o %5
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THORACIC SYMPATHETIC
CHAIN BLOCK
No! #se& +i&ely
ig" risk of pne#mo!"or*
Mi&&le n& lo+er !"orcic region
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LUMBAR SYMPATHETIC
BLOCK Nee&le in!ro&#ce& ! !"e level of
L( or L( / L)
$in relief !o pelvis n& lo+er limb
0ol#me re1#ire& 2 3 !o 45ml
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SUPERIOR HYPOGASTRIC
PLEXUS BLOCK
,rom splenic fle*#re of colon !o
mi&&le 'r& of rec!#m
$in relief !o pelvis n& lo+er limb
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Mos! &iffic#l! block !o perform
Nee&le "s !o en!er !"ro#g" smll
!ring#lr spce be!+een ilic cres!
n& !rnsverse process of L6
0ol#me re1#ire& 7 8ml for ec" si&e
SUPERIOR HYPOGASTRIC
PLEXUS BLOCK
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GANGLION IMPAR BLOCK
9l!"er:s gnglion 7 lies in fron! of
S(; S'
$in relief for lo+er rec!#m; nl cnl
n& perine#m incl#&ing v#lv n&
vgin
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$!ien! in li!"o!omy or l!erl posi!ion
Ben! 45cm nee&le in!ro&#ce& in fron! of
!"e coccy*
,inger inser!e& in!o rec!#m !o g#i&e
!"e nee&le close !o !"e scrl c#rv!#re
0ol#me re1#ire& 7 45ml
GANGLION IMPAR BLOCK
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Coeliac plexus block
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HISTORY
4<4) 2 =A$$IS 2 firs! block in l!erlposi!ion
4<(5 2 9ELDING 2 n!erior pproc".
4<(8 2 LABA% 2 no+ follo+e& re!rocr#rlpproc" in prone posi!ion.
4<3( 2 SINGLERS 2 C% g#i&e& !rnscr#rlpproc"
4<3'2 ISCIA 2 pos!erior !rnsor!icpproc"
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LOCATION
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FORMATION
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AREA OF SUPPLY
LOWER END OF ESOPHAGUS UPTO SPLENIC FLEXURE.
LIVER,SPLEEN
RETROPERITONEAL STRUCTURES LIKE PANCREAS,KIDNEY.
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INDICATIONS
Chronic malignant & non malignant visceral pain
4. -pper g.i. mlignncy
(. C"ronic pncre!i!is'. Ac#!e pncre!i!is
). Repe!e& b&ominl s#rgeries
6. I0 rel!e& sclerosing c"olngi!is>. Dignos!ic p#rposes
8. Ab&ominl ngin
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ROLE IN CHRONIC
PANCREATITIS
Controversial
Useful in Fe sele!"e# !$ses
A!u"e e%$!e&'$"i(ns
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ROLE IN ACUTE
PANCREATITIS
S"e&(i#s i)*&(+e# )(&'i#i"
$n# )(&"$li"
C(n"inu(us infusi(n f(& *$in &elie
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CONTRAINDICATIONS
ABSOLU!
An"i !($-ul$n" "e&$* C($-ul(*$"
An"i/'l$s"i! !$n!e& "e&$*
0(el ('s"&u!"i(n
P$"ien" (n #isulfu&$) "e&$*
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CONTRAINDICATION
"!LA#$!
D&u- see1in- 'e$+i(u& "( *$in
P$"ien" (n CNS #e*&ess$n" #&u
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TECHNIQUE
Posterior approach
Anterior approach
Re"&(!&u&$l An"e!&u&$l
"&$ns$(&"i!
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RETROCRURALAPPROACH
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RETROCRURAL APPROACH
0il$"e&$l P(s"e&i(& $**&($!
S*l$n!ni! 'l(!1
D&u- #e*(si"e# 'ein# "e !&us (f #i$*&$-)
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MARKINGS
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ANTECRURAL
APPROACH
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Unil$"e&$l $**&($!
Ri-" si#e# (nl
Nee#le *l$!e# $n"e&i(& "( !&us (f #i$*&$-).
ANTECRURAL APPROACH
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MARKINGS
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CO%#%UOUS
PL!US BLOC'
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COMPLICATIONS
(#%O"
?$O%ENSION
$OS%-RAL ?$O%ENSION
DIARREA
$AIN
CEMICAL COM$LICA%IONS
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COMPLICATIONS
C)!(#CAL
ALCO)OL
,ACIAL ,L-SING; $AL$I%A%IONS; DIA$ORESIS
P)!%OL
%RANSIEN% %INNI%-S; ,L-SING;MALAISE
CNS S%IM-LA%ION; M?OCLON-S; SEI@-RES;?$ER%ENSION;ARR?%MIAS;E$A%IC
RENAL INS-,,ICIENC?
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COMPLICATIONS
0ISCERAL IN-R?
EAC-LA%ION ,AIL-RE
NER0E ROO% IN-R?
MODERATEMODERATE
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COMPLICATION
$ARA$LEGIA
L-NG IN-R?
0ASC-LAR %RA-MA
E$ID-RAL S-B ARACNOID
INEC%ION
MAJORMAJOR
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EFFICACY OF COELIAC
PLEXUS BLOCKControversy Regarding
E2!$! &el$"i+e "( (*i(i# "e&$*
E2!$! &el$"i+e "( +$&i(us $**&($!e
C()i"")en" "( neu&(lsis #es*i"e &e) &is1 (f *$&$*le-i$
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ADVANTAGE OF
COELIAC PLEXUS NEUROLYSIS
0e""e& l(n- "e&) *$in &elief
De!&e$se #&u- #(se f(& )$in"$in$n!
0e""e& 3u$li" (f life
I)*&(+e# *e&f(&)$n!e s"$"us
O+e&!()es "e G.I.T e4e!"s (f (*i(i#
In ei-" $n# su&+i+$l &$"e
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Del$e# $**li!$"i(n
Tu)(u& e%"ensi(n
P((& "e!ni3ue
FAILURE DUE TO
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DRUGS
ALCOOL
$ENOL
LOCAL ANAES%E%ICS
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ALCOHOL
COMMONL? -SED
?$OBARIC
CE$ALAD S$READ RADIOGRA$ICALL?-SED IN CONCEN%RA%ION O, 657455
0OL-ME RE-IRED7)5 ml
ALCOHOL
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ALCOHOL
A*$A%A+!S
LONGER D-RA%ION O, AC%ION
EASIL? A0AILABLE
IMMEDIA%E NE-ROL?SIS
$AIN ON INEC%ION CON,IRMS CORREC%
$LACEMEN% IN %E BLIND A$$ROAC
LESS A,,INI%? ,OR 0ASC-LAR %ISS-ES
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ALCOHOL
*#SA*$A%A+!S
$AIN ON INEC%ION
CANNO% BE COMBINED 9I% D?E
PHENOL
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PHENOL
?$ERBARIC
CA-DAL S$READ
RADIOGRA$ICALL?
8.6 2 45 SOL-%ION $RE,,ERED
MAIM-M DOSE 2 )5 mgFkg
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PHENOL
A*$A%A+!S
NO $AIN ON INEC%ION
IMMEDIA%E ANAES%E%IC E,,EC%
CAN BE COMBINED 9I% D?ES
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PHENOL
*#SA*$A%A+!S NO COMMERCIAL $RE$ARA%ION
IG A,,INI%? ,OR 0ASC-LAR %ISS-ES
SOR%ER D-RA%ION O, AC%ION%AN ALCOOL
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LOCAL ANAESTHETICS
5.(6 B-$I0ACAINE $RE,,ERED ,OR
IN%ERMI%%EN% ADMINIS%RA%ION
>73 mlF"r 5, 5.4 B-$I0ACAINE
$RE,,ERED ,OR CON%IN-O-S
ADMINIS%RA%ION
=E$% ,OR MAIM-M O, 8 DA?S
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SUMMARY
Ve& useful "((l in "e$&)$)en"$&iu) (f "e In"e&+en"i(n$l *$in s*e!i$lis"
A**lie# e$&l f(& 'e""e& &esul"s
T&$inin- in "e PG *e&i(# un#e&e%*e&" $n#s is $ )us"
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