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 cut the nerve
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.
First, you have a small injection of local anaesthetic to numb your skin. The doctor then puts a long needle in through your back or chest to the coeliac plexus. During the procedure, you have x-rays or CT scans so your doctor can check the needle is in exactly the right place.
In some cases, you may have the needle put into the coeliac plexus through the stomach wall during an endoscopy.
Research has shown that up to 9 out of 10 people (up to 90%) with abdominal cancers can get short and long term pain relief with a coeliac nerve block.
Around 4 out of 10 people (around 40%) have diarrhoea after this treatment, but this usually gets better within a couple of days. A very small number of people have severe, ongoing diarrhoea afterwards.
Operation to cut the nerve
Your doctor might think it is better to cut the nerves causing the pain, instead of just 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 and the anaesthetist pushes a thin needle into the nerve. The needle has a laser or radiofrequency probe at the tip, which cuts the nerve. The anaesthetist may use ultrasound or a CT scan during the procedure, to make sure the needle is in the right place.
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 enables the surgeon to look inside the body.
You have either a general anaesthetic or a sedative. You have a few small cuts (incisions) made between your neck and breastbone. The surgeon uses the thoracoscope to look inside and find nerves that are part of a chain called the sympathetic nerve chain.
The surgeon then uses a laser or radiofrequency probe at the tip of the thorascope to block this chain of nerves.
Cutting the splanchnic nerve
The splanchnic nerves send signals from the spinal cord to the organs in the chest and abdomen. Pressure on the splanchnic nerves can cause continuing pain in some types of cancer.
Cutting the splanchnic nerve is called splanchnicectomy (pronounced splank-nik-ectomy). It can reduce pain for many people.
There are not usually many side effects to nerve blocks. You might have low blood pressure afterwards. The low blood pressure can make you feel light headed if you stand up too quickly. But this usually gets better over a few days.