"Splanchnic Nerve Block: A Safe and Effective Alternative to Celiac Blo" by Narjis Mumtaz, Arif Valliani et al.
 

Splanchnic Nerve Block: A Safe and Effective Alternative to Celiac Block for Median Arcuate Ligament-Syndrome

Document Type

Conference Proceeding

Publication Date

2024

Publication Title

Neuromodulation

Abstract

INTRODUCTION: Celiac artery compression syndrome is defined as chronic, recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. Also known as median arcuate ligament syndrome (MALS), it is a rare disorder characterized by a triad of postprandial abdominal pain, weight loss and abdominal bruit. Celiac plexus block is one of the diagnostic testing modalities for MALS alongside imaging. Common treatment for MALS is celiac artery decompression by resection of the median arcuate ligament and nerve fibers. Here we discuss splanchnic nerve block as a diagnostic modality and bridging analgesia till definitive surgical management.

CASE PRESENTATION: 21-year-old female with history of Ehler's Danlos Syndrome (EDS), Postural orthostatic tachycardia syndrome (POTS), sick sinus syndrome with pacemaker and MALS. She initially presented to pain clinic with abdominal pain for several weeks. Medical management was discussed with a follow-up. A week later, she ended up in ER with severe pain. Imaging showed 95% narrowing of celiac trunk by mass effect from the left hemi-diaphragmatic crus with normal distal branches of celiac axis. Vascular and general surgery were consulted. Due to multiple comorbidities including EDS that made her high risk for wound healing and hernia, optimization and family discussion was required for robotic release of median arcuate ligament. Pain team was consulted and we performed bilateral splanchnic nerve blocks with steroid giving her near-total relief of pain for 2months. Repeat intervention was performed in 3months while awaiting surgery which showed similar pain relief.

DISCUSSION: Celiac plexus is present adjacent to the median arcuate ligament. Pain associated with celiac artery compression syndrome may be mediated by celiac plexus, however this is controversial. Diagnosis of MALS includes imaging studies. Celiac ganglion block can also be used as provocative physiologic test. The rationale for ganglion nerve block is that symptoms of celiac artery compression syndrome may be due to inflammation and compression of nerve fibers of celiac plexus. In our institution, celiac plexus blocks are reserved for chronic cancer pain patients due to associated complications. We performed splanchnic plexus block in our young patient with chronic abdominal pain considering it a safe approach to avoid complications and hoped to achieve similar results. Patient had near-total relief of pain.

CONCLUSION: Splanchnic nerve block is a safer option with similar diagnostic and therapeutic results as celiac plexus block for MALS. Ethanol based neurolysis can also be used if surgery is not an option.

DISCLOSURES: Ketan Chopra: None, Narjis Mumtaz, MD: None, Arif Valliani, MD: None

Volume

27

Issue

7

First Page

S58

Last Page

S58

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