Common Neurolytic Blocks for Pain Management

8/9/2019 Common Neurolytic Blocks for Pain Management

http://slidepdf.com/reader/full/common-neurolytic-blocks-for-pain-management 1/55



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



NEUROLYTIC BLOCKS

%"e nerves "ve !"e !en&ency !o

regener!e

Blocking effec! is !emporry



DURATION

' mon!"s !o () mon!"s



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



STELLATE GANGLION

BLOCKStellate ganglion formed by union of

Mi&&le cervicl

Lo+er cervicl

,irs! !"orcic segmen!



STELLATE GANGLION

BLOCKPain relief to structures of

Neck ,ce

-pper limb -pper !"or* #p!o %5



THORACIC SYMPATHETIC

CHAIN BLOCK

No! #se& +i&ely

ig" risk of pne#mo!"or*

Mi&&le n& lo+er !"orcic region



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



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



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



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



$!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



Coeliac plexus block



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"



LOCATION



FORMATION



AREA OF SUPPLY

LOWER END OF ESOPHAGUS UPTO SPLENIC FLEXURE.

LIVER,SPLEEN

RETROPERITONEAL STRUCTURES LIKE PANCREAS,KIDNEY.



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



ROLE IN CHRONIC

PANCREATITIS

Controversial

Useful in Fe sele!"e# !$ses

A!u"e e%$!e&'$"i(ns



ROLE IN ACUTE

PANCREATITIS

S"e&(i#s i)*&(+e# )(&'i#i"

$n# )(&"$li"

C(n"inu(us infusi(n f(& *$in &elie



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&$*



CONTRAINDICATION

"!LA#$!

D&u- see1in- 'e$+i(u& "( *$in

P$"ien" (n CNS #e*&ess$n" #&u



TECHNIQUE

Posterior approach

Anterior approach

Re"&(!&u&$l An"e!&u&$l

"&$ns$(&"i!



RETROCRURALAPPROACH



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$*&$-)



MARKINGS



ANTECRURAL

APPROACH



Unil$"e&$l $**&($!

Ri-" si#e# (nl

Nee#le *l$!e# $n"e&i(& "( !&us (f #i$*&$-).

ANTECRURAL APPROACH



MARKINGS



CO%#%UOUS

PL!US BLOC'



COMPLICATIONS

(#%O"

?$O%ENSION

$OS%-RAL ?$O%ENSION

DIARREA

$AIN

CEMICAL COM$LICA%IONS



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?



COMPLICATIONS

0ISCERAL IN-R?

EAC-LA%ION ,AIL-RE

NER0E ROO% IN-R?

MODERATEMODERATE



COMPLICATION

$ARA$LEGIA

L-NG IN-R?

0ASC-LAR %RA-MA

E$ID-RAL S-B ARACNOID

INEC%ION

MAJORMAJOR



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$



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



Del$e# $**li!$"i(n

Tu)(u& e%"ensi(n

P((& "e!ni3ue

FAILURE DUE TO



DRUGS

ALCOOL

$ENOL

LOCAL ANAES%E%ICS



ALCOHOL

COMMONL? -SED

?$OBARIC

CE$ALAD S$READ RADIOGRA$ICALL?-SED IN CONCEN%RA%ION O, 657455

0OL-ME RE-IRED7)5 ml

ALCOHOL



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



ALCOHOL

*#SA*$A%A+!S

$AIN ON INEC%ION

CANNO% BE COMBINED 9I% D?E

PHENOL



PHENOL

?$ERBARIC

CA-DAL S$READ

RADIOGRA$ICALL?

8.6 2 45 SOL-%ION $RE,,ERED

MAIM-M DOSE 2 )5 mgFkg



PHENOL

A*$A%A+!S

NO $AIN ON INEC%ION

IMMEDIA%E ANAES%E%IC E,,EC%

CAN BE COMBINED 9I% D?ES



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



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



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"

Common Neurolytic Blocks for Pain Management

Documents

Transcript of Common Neurolytic Blocks for Pain Management