Nerve blocks

Your doctor might suggest a nerve block if you have pain that is difficult to treat. This is a way of killing or deadening a nerve to stop it causing pain.

There are different types of nerve block. Their names are to do with the nerves they treat.

Coeliac nerve block

What is a coeliac nerve block?

The coeliac plexus (pronounced seel-ee-ak pleck-sus) is a complicated web of nerves at the back of the abdomen. It can cause ongoing pain in people with pancreatic cancer and some other types of cancer in the abdominal area.

To block the pain, you can either have:

• an injection into the nerve

• a small operation to stop the nerve working

Injection into the nerve

For a nerve block using an injection, the doctor injects either local anaesthetic (with or without steroids ), or alcohol into the coeliac plexus. Alcohol gives a longer lasting block.

You’ll probably have medicine to make you drowsy (sedation ) before this procedure.

You usually have a long needle put into the coeliac plexus through the stomach wall during an endoscopic ultrasound (EUS) .

An EUS combines an ultrasound and endoscopy. Your doctor uses a long flexible tube (endoscope) with a tiny camera and light on the end. The endoscope also has an ultrasound probe at its tip. 

The ultrasound uses high frequency sound waves to create a picture of the inside of your stomach.

Your doctor passes the endoscope into your mouth and down your throat to the food pipe (oesophagus) until it reaches the stomach. The endoscope is slightly wider than a pen and will be uncomfortable but shouldn’t be painful.

They put a needle through the endoscope into your stomach and use the ultrasound to guide the needle into the coeliac plexus.

Instead of an endoscopic ultrasound, they sometimes use a CT scan to do the procedure. They put the needle through your skin into the coeliac plexus. They then put in the local anaesthetic or alcohol.

In some cases you may have the needle put in through your back or chest to the coeliac plexus. During the procedure, you may have either an x-ray, ultrasound or CT scan so your doctor can check the needle is in exactly the right place.

Research has shown that up to 90 out of 100 people (up to 90%) with abdominal cancers can get short and long term pain relief with a coeliac nerve block.

Side effects of a coeliac nerve block

Soon after a coeliac nerve block some people get diarrhoea. It usually gets better but a small number of people have severe, ongoing diarrhoea afterwards. Another side effect is a drop in blood pressure if you have been sitting or lying down.

Operation to stop the nerve working

Your doctor might think it is better to have an operation to stop the nerves from working, instead of injecting them. This is a small operation and you may have it done during other surgery to help relieve your symptoms.

Again, you might have sedation first. You then have a local anaesthetic to numb the skin and the anaesthetist pushes a thin needle into the nerve. The needle has a radiofrequency probe at the tip, which destroys the nerve. This is known as radiofrequency ablation (RFA). Or it uses a laser. Both of these use heat to kill a part of the nerve. The anaesthetist may use an ultrasound or CT scan during the procedure to make sure the needle is in the right place.

Your doctor may suggest a treatment where they use extreme cold to destroy the nerve. This is known as cryoablation.

Thoracoscopic sympathectomy

Another type of nerve block is called thoracoscopic sympathectomy. This means the doctor uses a thoracoscope  to reach the nerves in the chest. This is a tube with a camera, eyepiece and light that helps the surgeon to look inside the body.

You have either a general anaesthetic or sedation. Your surgeon makes a few small cuts (incisions) between your neck and breastbone. They use the thoracoscope to look inside and find nerves that are part of a chain called the sympathetic nerve chain.

Your surgeon then uses a laser or radiofrequency probe at the tip of the thoracoscope to block this chain of nerves.

Side effects

The possible side effects of the nerve block you have can vary depending on the nerve being treated.

Generally, a nerve block changes what you feel (the sensation) in the affected area. So it may feel numb or heavy for instance. It should also help relieve any pain that you were getting from that nerve. This might only last for a short time or may be permanent. You might have additional nerve block treatments if it wears off. In some cases it may not help at all and you will have other pain relief to help.

A nerve block can also affect the use of muscles connected to that nerve being treated. So the muscle may seem weak and not have the strength it had before.

Your healthcare team can explain in more detail about what to expect.