Celiac Plexus Block for Nissen Fundoplication Pain Management
Celiac plexus block is not recommended for pain management following Nissen fundoplication surgery as there is no evidence supporting its use for this indication, and it should be reserved primarily for cancer pain, particularly pancreatic cancer.
Indications for Celiac Plexus Block
Celiac plexus block (CPB) has specific, evidence-based indications that do not include post-Nissen fundoplication pain:
- Primary indication: Pain from pancreatic cancer (72-80% efficacy) 1
- Limited efficacy in chronic pancreatitis (51-59% efficacy) 1
- Specifically recommended against routine use in chronic pancreatitis 1
- No evidence supporting use for post-surgical pain following Nissen fundoplication 2
Anatomical Considerations
The celiac plexus innervates specific abdominal organs:
- Liver, pancreas, spleen, omentum
- Alimentary tract to mid-transverse colon
- Adrenal glands and kidneys 3, 4
Nissen fundoplication involves the gastroesophageal junction and proximal stomach, which are primarily innervated by the vagus nerve rather than the celiac plexus. This anatomical mismatch makes celiac plexus block inappropriate for targeting post-fundoplication pain.
Appropriate Pain Management for Nissen Fundoplication
Instead of celiac plexus block, post-Nissen fundoplication pain should be managed with:
Standard multimodal analgesia:
- NSAIDs
- Acetaminophen
- Short-term opioids as needed
For refractory cases:
- Intercostal nerve blocks
- Thoracic epidural analgesia
- Thoracic paravertebral blocks
Risks and Complications of Celiac Plexus Block
Using celiac plexus block for an unproven indication exposes patients to unnecessary risks:
- Hypotension
- Diarrhea
- Retroperitoneal hematoma
- Peripancreatic abscess formation 1
- Neurologic complications 5
Conclusion
Celiac plexus block should be reserved for its evidence-based indications, primarily pancreatic cancer pain. For Nissen fundoplication, standard post-surgical pain management approaches are more appropriate and supported by evidence. The American Gastroenterological Association and other guidelines do not support using celiac plexus block for post-surgical pain management in this context 1, 2.