8th January 2024

Nerve blocks

There are several different interventional pain management strategies. These are complex and performed comparatively rarely. For the purpose of the exam, being aware of the options for nerve blockade will be sufficient.

Nerve blockade involves the injection of drug (typically alcohol or phenol) into a part of the peripheral nervous system to reduce pain. This is considered where medications have not controlled the pain, and a nociceptive pathway is clearly identified. It is useful in visceral nociceptive pain, and intervention prevents nociceptive activity in the nerve. This isn’t an option in neuropathic pain, where the nerve is already damaged.

Celiac plexus block

The celiac plexus innervates the upper abdominal organs and is frequently implicated in pain related to pancreatic cancer. The plexus is accessed either percutaneously with CT guidance or endoscopically under ultrasound guidance. This is a safe procedure, and data suggest it provides excellent pain relief.

Superior hypogastric block

This is an option for visceral pelvic pain, often associated with pelvic malignancies. This is usually accessed intraoperatively or through CT guidance.