Coeliac axis block, subarachnoid block, intrathecal and epidural blocks, peripheral nerve blocks, sympathetic and visceral nerve blocks, cordotomy.

Currently the most useful neurolytic block is coeliac axis block. However, neurolytic blocks of the subarachnoid space, autonomic system and peripheral nerves are occasionally indicated.

Coeliac axis block is normally indicated for cancer of the pancreas.. It may also be indicated for pain from upper abdominal malignancies. Coeliac axis block has a high success rate with 70% of patients experiencing good analgesia. The effect of the block can last at least three months.

An alternative to coeliac axis block is to place neurolytic agents on thee splanchnic nerves .

One difficult decision is to decide when to do the block. In the past there was a tendency to do too late. Recently doctors tend to offer the block to patients much earlier.

How about subarachnoid block?

Neurolytic subarachnoid block was used extensively prior to the development of continuous intrathecal drug administration. Recently, it is commonly used to control perineal pain with saddle block.

How about the remaining blocks?

Intrathecal neurolytic lesions can be made for specific nerve root involvement. !00% alcohol is often used. Epidural phenol neurolysis has also been described and is technically much easier. Neurolytic solutions can also be placed around peripheral nerves. Besides the major sympathetic block of the coeliac axis, there are other areas of the sympathetic nervous system that can be blocked for diagnostic and therapeutic purposes. Occasionally there may be a reason to perform somatic nerve blocks such as inrecostal nerve block or greater occipital nerve block. Percutaneous high cervical anterolateral cordotomy can occasionally be useful in controlling intractable pain.