The splanchnic nerve block procedure involves blocking the splanchnic nerves to relieve abdominal pain. It is performed under x-ray guidance with the patient prone. Needles are advanced under the ribs toward the vertebral body while monitoring placement with contrast dye. Radiofrequency lesioning is then used to ablate the nerves, after which steroids are injected to prevent neuritis. Patients are monitored for side effects like hypotension before being discharged with instructions.

1. DR. KRISHNA PODDAR
KOLKATA PAIN CLINIC
BELLEVUE CLINIC
FORTIS HOSPITAL
KOLKATA
wwwkolkatapainrelief.com
SPLANCHNIC NERVE BLOCK

2. ANATOMY
• The splanchnic nerves are formed by the
greater, lesser, and least splanchnic nerves.
• The greater splanchnic - T5–T10 spinal roots.
• The lesser splanchnic nerve -T10–T11 roots
• the least splanchnic nerve arises from the T11–
T12 spinal roots.
• They are preganglionic fibers entering the celiac
plexus.
• These nerves lie in a narrow tubular space
bounded by the vertebral body medially, pleura
laterally, the posterior mediastinum ventrally,
and crura of the diaphragm caudally

3. Indications
• Pain syndromes involving upper abdominal viscera.
• Acute and chronic pancreatitis
• Cancer pain from the upper abdominal viscera

4. Contraindications
• Local infection
• Coagulopathy
• Psychopathologies
• Distorted anatomy due to tumor invasion.
• Abdominal aorta aneurysm.
• Pleural adhesions.

5. HOW TO DO
• The intervention is performed under X-ray guidance.
• The patient is placed in a prone position on a translucent table with a
pillow underneath the abdomen in order to reduce lumbar lordosis.
• intravenous infusion line is placed .
• O2 canula
• Monitoring of vital signs is mandatory.
• The area for needle entry is prepared in a sterile fashion.
• The procedure takes place under sedation with propofol or fentanyl
and spontaneous respiration.

6. Equipment and drugs for the technique
• 5ml syringe for local anesthetic.
• 2 inch needle for local infiltration.
• Two 10cm, 22 gauge needles for the splanchnic block.
• 1–10syringe with Omnipaque (contrast solution)
• 1% lidocaine for skin infiltration or for diagnostic
• 5 ml 0.5% bupivacaine and 40 mg methylprednisolone each side
• RF machine.
• 15cm curved RF needle with 15mm electrode tip.

7. PROC EDURE
1. Place the C-arm for posteroanterior
view of the T10–L2 region
2. Then rotate the C-arm approximately
45°
3. The lateral side of the T12 vertebral
body should be in view.
4. The point of entry is at the junction of
the rib and vertebral body
5. Infiltrate the skin with 1% lidocaine.
Insert a 10cm, 22 gauge needle through
the skin and advance under fluoroscopy
using tunneled vision.

9. PROCEDURE
• After advancing 1–
1.5cm anteriorly, turn
the C-arm laterally
• Advance the needle
until it reaches the
junction of the anterior
one-third and posterior
two-thirds of the
vertebral body.
• One should always have
a bony contact with the
vertebral body while
advancing the needle.

11. 1. Now position the C-arm for
the posteroanterior view
again to verify the bony
contact of the needle with the
vertebral body
2. Aspirate for blood or
cerebrospinal fluid
3. Confirm the position of the
needle- Inject 5ml of contrast
material.
4. On the posteroanterior view
the contrast material will
spread adhering to the T10,
T11, or T12 vertebral body.

12. 1. A smooth contoured
image will appear in the
lateral view. The tip on the
lateral view should
stay retrocrural to the
aorta
2. For diagnostic and
prognostic purposes inject
5 ml of 1% lidocaine
bilaterally

13. R F LESIONING
• The RF generator is connected
• The impedance should be lower
than 5000 Ohm.
• The patient will feel a vibrating sensation in epigastria at 50 Hz and a threshold
of less than 1 V.
• motor stimulation at 2 Hz Normally, no stimulation is felt.
• When the test results are positive, local anaesthetic is administered (2-3 ml
lidocaine 2% .
• For each level, the treatment consists of three times 90 seconds at 80°C.
• the needle is first turned with its curve in a cranial, then in a neutral, and finally
in a caudal direction.
• After RF lesioning, 40mg of triamcinolone is injected to prevent neuritis

15. Postprocedure care
After the procedure is completed, the patient needs to be observed for
at least 2 hours.
Monitoring of vital signs is mandatory.
Pain relief one should document it.
The patient should be discharged with adequate instructions given to
their escort.
Written instructions are preferable for emergencies and are helpful to
the patient and their family.

16. COMPLICATIONS
• Hypotension and diarrhoea
• collapsed lung.
• anaesthesia of the phrenic nerve.
• Thoracic duct injury
• Intradiscal and intravascular injection
• Paraesthesia
• Paraplegia is rare,

17. “Greatest happiness that mankind could gain,
Is not in pleasure but relief from pain”