Overview

The coeliac plexus (also called the solar plexus) is a group of nerves in your upper abdomen (tummy). Sensory signals from your pancreas, liver, and sometimes your upper intestines, go through this point, to your brain. Pain signals from these organs go through the coeliac plexus and they can be interrupted by an injection of local anaesthetic to this area. This is called a coeliac plexus block.

Careful consideration of the potential benefits and risks is needed, to make sure that this is the right treatment for you. Sometimes, for cancer-related pain, a substance (using phenol or alcohol) is also used, to destroy nerves in the coeliac plexus.

Possible side effects

As with any procedure, side effects can happen. These are usually minor but there can be major risks too, and some side effects can be permanent.

Common side effects

• Mild tenderness and bruising at the injection site. This usually settles over a few days, but sometimes people have back pain for longer.
• Blood pressure might be low. The nurse will check regularly before you leave hospital. Care will be taken after you first stand up and walk after the procedure. You might need to have a drip inserted and be given fluids to help get your blood pressure back to normal. Some clinics ask for special compression stockings (TED stockings) to be worn.
• Your digestive system might be affected by the procedure. If you have problems with sickness they usually improve. You might notice your poo is runnier than usual, and might get diarrhoea. Let your doctor know if this is a problem. It is important that you do not get dehydrated after the procedure.

Rare side effects

• Some local anaesthetic might spread, causing numbness and weakness in your legs and other areas. If this happens, it’s usually temporary and will resolve within minutes, or sometimes hours.
• Injection treatments are not always effective and might not ease your pain.
• Infections are rare, but can happen. This might need treatment with antibiotics.

Very rare side effects

• Local anaesthetic is accidentally injected into a vein (intravascular). This might mean you need more medical treatment.
• Difficulty with sexual function (males only). Your doctor can discuss this with you.
• Paralysis, but your doctor will discuss this fully with you.
• Internal organs can get punctured or damaged, and this might require treatment.
• Bleeding from a puncture to a major blood vessel. This would need careful monitoring or further tests, and very rarely, surgery.

Other treatment options

These will be discussed with you before you decide on any treatment. The decision about whether to have the injection is shared between you and your doctor. Your doctor can give you up-to-date information about the chances of this being a successful treatment for you, and how this treatment fits into your care.

If you are unsure about having these injections, your doctor can give you more information, so that you can make an informed decision.

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what the treatment involves and agree to have it.

Read more about our consent process.

Before treatment

Always bring a list of all your current medicines. This includes any you buy from a pharmacy or shop, and any herbal or homeopathic remedies.

Continue to take your medicines as usual on the treatment day unless you are taking medicines that thin the blood (such as warfarin, rivaroxaban, heparin, or clopidogrel). If you are unsure, or if you take these medicines, please contact us at least 2 weeks before your injection, to help us manage these.

It is important that you tell us if your health has changed. For example, if you:

• have an infection in your body, or on the skin of your back (your doctor will delay the treatment until the infection is cleared)
• have started taking anticoagulant or antiplatelet medicines that thin the blood (such as warfarin, rivaroxaban, heparin or clopidogrel), as this might need more preparation
• take anti-retroviral medicines, as these can interact with the steroids used in the injection
• have any allergies

You must also tell us if there is any chance that you could be pregnant.

If you are planning to fly or travel abroad in the 2 weeks after the injections, please let us know as it might be best to change the date of your injections.

During treatment

Doctors give these injections in slightly different ways, but this is generally what will happen.

• Your blood pressure and pulse rate will be monitored.
• A small needle (cannula) will be placed in the back of your hand.
• You will be carefully positioned, and the skin around the injection sites will be cleaned with an antiseptic solution or spray. This can feel very cold.
• An X-ray machine (or other form of image guidance) will be used to make sure we give the injections accurately.
• You will feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. Your doctor will warn you of this first.
• The doctor will give the injections to the areas suspected to be a source of pain. When the injections are given, you might feel pressure, tightness or a pushing sensation. If there is any discomfort, let the doctor know.

After the injections

After the injections you will be taken to a recovery area where nursing staff will monitor you.

You will be told when you can get dressed, and be helped to make sure that you can stand safely after the procedure.

Your pain will be assessed at rest and during your usual daily activities, such as walking and moving your back, to find out how much pain relief you have immediately after the injections.

Leaving hospital

You can usually leave hospital within a few hours after the injections and, sometimes, much sooner. This will depend on how long your doctor or nurse wants you to stay for in recovery.

Please make sure that you have arranged for someone to collect you after the procedure and escort you home. If you do not do this, your procedure will probably be cancelled.

It is unsafe for you to drive home immediately after the procedure. If you do, your car insurance will be invalid.

You should arrange for someone to stay with you for 24 hours after treatment. If that is not possible, you should at least have access to a phone.

For the first 24 hours after your procedure, you should follow these instructions.

If you are unsure, please discuss these issues with your doctor.

If you have any sterile dressings, you can remove them before going to bed.

You might get some soreness or aching at the injection site. Please keep the injection area dry for 24 hours after the procedure.

Do not worry if your pain feels worse for a few days, as this sometimes happens. Your doctor will give you advice about the use of regular painkillers after the injections.

You can usually resume normal activities after the procedure, unless your doctor tells you otherwise.

It’s OK to restart your exercise or physiotherapy as soon as you feel comfortable doing so.

When to get help

Before you go home, you will be given information about who to contact if the pain unit is closed.

After the injections

As your pain decreases, you should try to gently increase your exercise. Simple activities, like a daily walk, using an exercise bike or swimming on your back, will help to improve your muscle tone. Your doctor can give you more specific advice.

It is best to increase your activities slowly. Try not to do too much on a good day, as it can mean you struggle with more pain the next day.

Returning to work

This will be different for everyone and will depend on the nature of your work. You should discuss this with your doctor.

Follow-up appointments

You will receive a text message or letter with a follow-up appointment date and time. The appointment will be a phone call with a nurse specialist or consultant, or in clinic with a consultant. If you haven’t heard from us within 10 weeks after the procedure, please phone 020 7188 4714, Monday to Friday, 9am to 5pm.