Treatment for upper and lower abdominal pain

The coeliac plexus and splanchnic nerves together form a nerve network that plays an important role in transmitting pain signals from the abdominal organs to the brain. The coeliac plexus is located just anterior to the spine and anterior to the aorta, at the level of the upper lumbar vertebra L1. The plexus is formed by the splanchnic nerves, which originate from the thoracic (upper back) nerve cord.

The hypogastric plexus is a nerve network that plays an important role in transmitting pain signals from the organs in the pelvis and lower abdomen to the brain. This plexus is located deep in the pelvis, just in front of the spine, at the level of the lower lumbar vertebrae (L5) and the sacrum. The nerve network is formed by fibres originating from the lower lumbar (lower back) and sacral nerve strands.

By blocking the nerves of the plexus coeliacus or the splanchnic nerve, we aim to reduce upper abdominal pain and/or opioid use. In chronic pancreatitis, we use diagnostic blockade, with local anaesthesia, to check whether further (radiofrequency) treatment is useful or not. In oncological problems, immediate neurolysis (chronic nerve interruption) may be performed.

Preparation

In the operating theatre, the nurse places an infusion in the arm. Antibiotics will be administered to reduce the risk of infection. Afterwards, you will be allowed to lie on your stomach on the operating table.

The anaesthetist will administer a light anaesthetic through the drip. Your heart rhythm, blood pressure and oxygen in the blood are constantly monitored during the treatment.

Your skin will be disinfected, which may feel cold for a while. The exact puncture site is determined using a device with X-rays. Your skin will then be locally anaesthetised in two places. You will gradually fall asleep. The needles are placed on both sides at the level of the coeliac plexus or splanchnic nerve. The position of the needles is checked by administering contrast dye. Afterwards, the trial blockade or definitive blockade can be done.

Trial treatment

In a trial treatment, the nerve is briefly numbed to check the effect on your pain. When your pain symptoms are directed through this nerve, you will experience pain relief for several hours. If a trial blockade is temporarily successful, you can proceed to a definitive treatment of the nerve.

Definitive blockade with phenol or alcohol

Sometimes the choice is made to perform a definitive treatment immediately. This involves injecting a mixture of local anaesthetic and alcohol (or phenol) around the nerve to block the route of pain signals.

Definitive blockade by Radiofrequency (RF) treatment

Radiofrequency treatment proceeds largely like the trial treatment. We use different needles whose tip we can heat up. When the needles are in the right place, the anaesthetist wakes you up to test the correct position of the needles. This is done using small currents, which may cause a slight tingling in the stomach area. When the needles are in the exact position, the anaesthetist will put you back to sleep and the nerve is locally anaesthetised. Afterwards, the RF treatment can start, which uses radiofrequency current to generate heat that interrupts the conduction of pain.

When the treatment is finished, you will be woken up again.

After treatment

After treatment, you are taken to the recovery room where your blood pressure, heart rate and pain are further monitored. If necessary, an additional painkiller may be administered. The blockage is done just below the chest, where there is a small risk of the lung being punctured (pneumothorax). To rule this out, a check-up picture of the lungs is taken after an hour. As soon as you feel well, you may return to your room.

The brochure below explains more about:

• splanchnic nerve - plexus coeliacus/hypogastricus blockade
• possible side effects and complications

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Latest publication date: 24/01/2025
Supervising author: Dr. Decaigny Veronique