Celiac plexus block: A diagnostic tool for neurogenic median arcuate ligament syndrome

Author:

Bower Kathryn S.1ORCID,McCarthy Chloe C.1,Vyasa Parth1,Nagarsheth Khanjan2,Desai Mehul J.13ORCID

Affiliation:

1. Department of Clinical Research International Spine, Pain & Performance Center Washington DC USA

2. Department of Vascular Surgery University of Maryland Medical System Baltimore Maryland USA

3. George Washington University, School of Medicine and Health Sciences Washington DC USA

Abstract

AbstractObjectiveThe objective of this study was to evaluate the effect of outpatient celiac plexus block on acute pain reduction in patients with suspected median arcuate ligament syndrome.MethodsThis is an Institutional Review Board approved, retrospective chart review. Data were collected and analyzed from patients who received celiac plexus blocks from November 1, 2021 through April 6, 2023. The primary outcome was pain reduction, determined by the change in numerical pain rating scale (NPRS) from pre‐procedure to post‐procedure. Additional data collected include patient demographics, comorbidities, preoperative symptoms and duration of symptoms.ResultsThere were 33 patients identified in this study. Thirty‐one patients were included in the data analysis. The median age of the cohort was 29 years, and the median BMI was 20.4. 94% of the cohort was female. These patients were referred as part of an evaluation for symptomatic vascular compression disorders. For many patients, positive response to celiac plexus block was used as an indication to proceed with surgical MALS resection. We provide a diagnostic algorithm for MALs. All patients endorsed preoperative symptoms. Patients experienced a median pain reduction of −4 from baseline to immediately post‐procedure.ConclusionsCeliac plexus blocks continue to be a tool for ruling out neurogenic median arcuate ligament syndrome in patients who have undergone extensive previous imaging and assessments for vascular compression disorders. Our data suggest that patients with suspected MALS may experience substantial immediate pain relief from temporary blocks of the celiac ganglion as guided by fluoroscopy in an outpatient setting.

Publisher

Wiley

Reference22 articles.

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2. Celiac artery compression syndrome as an uncommon cause of intractable postprandial abdominal pain: a case report;Mahgoub AM;Cureus,2022

3. Median Arcuate Ligament Syndrome Is Not a Vascular Disease

4. Prevalence of signs of celiac axis compression by the median arcuate ligament on computed tomography angiography in asymptomatic patients

5. Celiac plexus block – an old technique with new developments;Vig S;Pain Physician,2021

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