The celiac plexus (a network of nerves deep in the upper abdomen, in front of the spine) and the splanchnic nerves (discrete nerve bundles running alongside the upper back/thoracic spine) both carry pain signals from your upper abdominal organs — pancreas, liver, gallbladder, stomach, spleen, and intestines. Treating both together in one session aims for more complete and longer-lasting relief than targeting either alone, particularly for severe pancreatic-related pain.

Local anaesthetic is used first to confirm the response; a steroid may be added to reduce inflammation. Depending on your situation — particularly for cancer-related pain — a neurolytic agent (alcohol or phenol) may be used at one or both sites for longer-lasting nerve disruption. Your specialist will discuss which combination is most appropriate for you.

This procedure may help if you have:

• Pancreatic cancer pain
• Chronic pancreatitis pain
• Severe upper abdominal (visceral) pain from other benign or malignant causes
• Pain that has not responded adequately to medication or a single-site nerve block

It isn't possible to guarantee how any individual will respond. As a general guide:

• Local anaesthetic: works within minutes and wears off after a few hours — a good early sign of response.
• Steroid: starts working after a few days and the effect can last for weeks or sometimes longer.
• Neurolytic agent (alcohol/phenol), when used: benefit can last weeks to several months; your specialist will discuss expected duration for your specific treatment.

This procedure is generally considered safe when performed under X-ray, CT, or ultrasound guidance, though as with any medical procedure the degree of benefit varies and cannot be guaranteed. Treating two nerve targets in one session means the risks of each are both relevant.

Common, minor effects:

• Temporary low blood pressure, which can cause light-headedness or dizziness on standing
• Temporary diarrhoea or loose stools, and abdominal cramping, as the nerve supply to the bowel is affected
• Temporary soreness at the injection sites or in the back
• Temporary rise in blood sugar for 1-2 days if steroid is used, particularly if you have diabetes

Rare, more serious risks:

• Infection or bleeding at the injection site
• Injury to nearby abdominal organs or major blood vessels (celiac plexus component)
• Pneumothorax (partial lung collapse) or injury to chest blood vessels (splanchnic component), which may require monitoring or a chest drain
• Temporary leg weakness (rare)
• Nerve injury, which is very rare
• Allergic reaction to the local anaesthetic, steroid, or contrast dye
• Small increased lifetime risk from the imaging (X-ray/CT) exposure used to guide the procedure
• Serious sedation or anaesthetic complications, very rarely including stroke or death
• Minimal or no improvement in pain

• Tell us about any blood-thinning medication (e.g. warfarin, clopidogrel, rivaroxaban) well in advance — special arrangements may be needed and you may be asked to pause these under guidance
• Tell us if you are, or might be, pregnant — this procedure uses X-ray or CT guidance
• Tell us about any allergies, including to contrast dye, local anaesthetics, or reactions to previous injections or anaesthesia
• Do not eat or drink for 6-8 hours before the procedure
• Bring a list of your current medications
• Arrange for a responsible adult to drive you home and stay with you for at least 6-12 hours afterwards, given the sedation and combined nature of this procedure

• Sedation is given to keep you relaxed but awake
• You will lie on your stomach or back, depending on the approach used
• The skin is cleaned and numbed
• Using X-ray, CT, or ultrasound guidance, needles are placed near the splanchnic nerves (near the upper back/spine) and the celiac plexus (near the front of the spine)
• Contrast dye confirms correct needle placement before treatment
• Medication is injected at both nerve targets
• The procedure usually takes 45-75 minutes given the two targets treated

• You will be monitored briefly in recovery before going home
• Some soreness at the injection sites is common for 1-3 days — simple pain relief (e.g. paracetamol) usually helps
• You may remove the small dressing after 24 hours, keeping the area clean and dry
• You may feel light-headed on standing for a day or two — stand up slowly and ask for help if needed
• Rest for the remainder of the day
• Avoid driving, alcohol, and making important legal or financial decisions for 24 hours
• Resume your usual diet and medications unless specifically advised otherwise

Contact your GP, Total Pain Clinic, or your nearest Emergency Department if you notice:

• New or worsening leg weakness or numbness
• New shortness of breath or chest pain
• Increasing redness, swelling, or discharge at the injection site
• Fever or feeling generally unwell
• Severe pain not settling with simple pain relief

A review appointment is usually arranged 2-4 weeks after your procedure to discuss how you responded and plan next steps — please call Total Pain Clinic reception to schedule this if it hasn't already been arranged. Please ask your doctor any questions before you proceed; you will be asked to sign a consent form if you agree to go ahead.