A celiac plexus block is a pain management procedure that interrupts nerve signals from the abdomen to the brain. It targets a large bundle of nerves called the celiac plexus (also known as the solar plexus), which sits deep in the abdomen near the aorta, roughly behind the stomach at the level of the upper lumbar spine. The procedure is most commonly used for severe abdominal pain caused by pancreatic cancer, which produces significant pain in 50 to 70% of patients.
What the Celiac Plexus Does
The celiac plexus is a dense network of nerve fibers that relays sensation and autonomic signals between your abdominal organs and your brain. It provides nerve supply to the liver, gallbladder, stomach, pancreas, spleen, kidneys, small intestine, and the first two-thirds of the large intestine. Among its many functions, this network carries pain signals from those organs to the central nervous system.
When disease or a tumor affects one of these organs, the celiac plexus becomes a highway for pain. A celiac plexus block works by injecting medication directly around this nerve bundle to stop those pain signals from reaching the brain. The organs themselves still function, but the perception of pain is dulled or eliminated.
Who Gets This Procedure
The most common reason for a celiac plexus block is unresectable pancreatic cancer. Tumors in the pancreas can press directly on the plexus, producing severe upper abdominal and back pain that often responds poorly to standard pain medications. When oral painkillers aren’t providing enough relief, or when their side effects (nausea, constipation, drowsiness, confusion, or risk of dependence) become unacceptable, a celiac plexus block offers an alternative route to pain control.
The procedure is also used for chronic pancreatitis and, less commonly, for pain originating from other upper abdominal organs supplied by the celiac plexus, such as the gallbladder or liver.
Block vs. Neurolysis
There are two versions of this procedure, and the distinction matters. A celiac plexus block uses a local anesthetic to temporarily numb the nerves. The effect wears off over time, and the procedure can be repeated. A celiac plexus neurolysis uses a chemical agent, typically concentrated alcohol (ethanol) or a 7% phenol solution, to destroy the nerve fibers and produce longer-lasting relief. Neurolysis is generally reserved for cancer pain, where permanent nerve destruction is an acceptable trade-off for sustained comfort.
In practice, a small amount of local anesthetic is often injected first to numb the area before the neurolytic agent is delivered. Phenol has a built-in advantage here: it produces an immediate numbing effect on its own, so a separate anesthetic injection may not be needed. Phenol is sometimes chosen for patients who can’t tolerate alcohol.
How the Procedure Works
The celiac plexus sits in a difficult-to-reach spot, nestled around the celiac artery and superior mesenteric artery near the T12 and L1 vertebrae, anterior to the spine and posterior to the stomach. To reach it safely, the procedure is performed under imaging guidance, typically using CT scanning, fluoroscopy (real-time X-ray), or endoscopic ultrasound.
You’ll generally lie face down for a back-approach technique, or the procedure may be done through the stomach wall using an endoscope passed through the mouth. A needle is guided into position near the plexus, and once correct placement is confirmed on imaging, the medication is injected. The entire process typically takes 45 minutes to an hour.
How Well It Works
Neurolysis has an efficacy rate of roughly 80%, reducing pain for weeks to months. In studies of pancreatic cancer patients, pain intensity dropped significantly after the procedure compared to pre-treatment levels. For many patients, this also means reducing the amount of oral pain medication they need, which in turn reduces side effects like constipation and sedation.
Pain relief is not always permanent. Nerves can regenerate, and cancer can progress, so the procedure may need to be repeated. But for patients with advanced cancer, even several months of meaningful pain relief represents a substantial improvement in daily life.
Common Side Effects
Most side effects are temporary and predictable. The two most common are diarrhea and a drop in blood pressure (hypotension). Both occur because the celiac plexus carries autonomic nerve fibers that help regulate gut motility and blood vessel tone. When those signals are interrupted, the gut speeds up and blood vessels dilate. These effects typically resolve on their own within days.
Other common but transient side effects include nausea, vomiting, constipation, and localized pain at the injection site.
Rare but Serious Complications
Serious complications occur in fewer than 2% of cases. Neurological problems, including weakness, sensory changes, or partial paralysis in the legs, happen in about 1% of procedures. Permanent paralysis has been reported in only 0.15% of cases, caused by disrupted blood flow to the spinal cord when a critical artery near the spine is damaged or goes into spasm during the injection.
Vascular complications are rare but can be severe. There are case reports of aortic injury during the procedure, particularly with approaches that pass the needle near or through the aorta. These events are exceptionally uncommon but underscore why imaging guidance and an experienced proceduralist are essential.
What Recovery Looks Like
Recovery is relatively quick. After the procedure, you’ll be monitored briefly and then discharged the same day. MD Anderson Cancer Center advises patients to take it easy and avoid intense physical activity for the first 24 to 36 hours. You’ll need someone to drive you home.
If you’re undergoing chemotherapy or other cancer treatments, timing matters. Whether you can resume other treatments the same day depends on your individual situation and should be coordinated with your care team beforehand. Most people notice changes in their pain levels within the first day or two, though it can sometimes take slightly longer for the full effect to develop.