Splanchnic Nerves Block /Lesion

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 24 January, 2012


The pain signals from visceral organs of the upper abdomen (pancreas, liver, spleen, gall bladder, stomach, small intestine, kidney, adrenal gland) are transferred to the spinal cord and from there to the brain via the splanchnic  nerves.

The splanchnic nerves are three, the greater, the minor and the least, emerging from the roots of the thoracic spinal nerves, are located bilaterally in the thoracic spine. At the levels of the 11th and 12th thoracic vertebrae, at the side sides of the vertebrae  bodies, these nerves pass through a narrow and clearly defined area above the arch of the diaphragm, retroperitoneal and in a safe distance from the great vessels (aorta, vena cava )


Turning off the splanchnic nerves is an absolute indication in patients suffering from malignant disease of the pancreas or other organs of the abdomen that receive innervation from the splanchnic l nerves, and suffering from visceral abdominal pain with or without reflection in the back.
The block also applies to abdominal pain from chronic pancreatitis and in patients with indeterminate without clear justification, chronic visceral abdominal pain.


The technique is applied to the patient in the prone position under local anesthesia in the puncture site, and under fluoroscopic guidance.

Generally the technique can be performed in the following ways:

1. Injection of local anesthetic at the crossing of splanchnic nerves,  through a special needle directed beside the body of the 11th thoracic vertebra and in direct contact with it, bilaterally. The duration of the block is limited and depends on the duration of action of local anesthetic used. Applied mainly for diagnostic purposes in cases of benign chronic abdominal pain.  If the patient finds significant improvement in pain, followed by permanent block with a different technique.
2. Lesion  of splanchnic nerves  by injecting large amounts of alcohol 95%. With this technique the nerves stop transferring the painful stimuli over a long period of time, approximately 2 to 3 months. The disadvantage of this technique is that there is no control over the dissemination and spread of the spirit, so that due to the large volume, injection destroys in some cases adjacent nerves, blood vessels and soft tissues.
3. The most effective and safe method of lesion of the splanchnic  nerves  is thermal  lesion with conventional  radiofrequency. This is achieved by hybrid needle-electrode which  is placed using fluoroscopy in the lateral body of the 11th and 12th thoracic vertebrae, bilaterally. The electrodes are wired to a radio frequency generator and then placing them next to the nerves,  goal is stimulation of nerves with low intensity current, so in collaboration with the patient to identify the nerves in the least possible distance from the active tip of the electrode. Then given a small amount of local anesthetic followed by radiofrequency application, which increases local and totally controlled the temperature to levels of destruction of the nerve. The major advantages of the technique is the long duration of effect and perfectly controlled and targeted burning nerve target.


Generally the technique, when it is run by experienced and trained doctor, is low risk for serious complications. Rarely can cause a small pneumothorax, usually the patient does not need any special treatment, and he is simply monitored for a few days.

Often patients after successful lesion of splanchnic  nerves,  show hypotension during the first hours after application of the technique and increased bowel movements on the second day of surgery. Increased bowel movements may occur intestinal colic and diarrhea. The symptoms are usually treated with anticonvulsant and usually subside after three days.


Immediately after the application of radio frequency technique, patients with malignant disease of the pancreas or the visceral organs of the upper abdomen, knowing full relief from the intense and durable, even in strong opioid medications, pain. It is a beneficial therapeutic technique for the treatment of very prominent and often unbearable malignant abdominal visceral pain.

Radiofrequency lesion of splanchnic  nerves is recommended even in early stages of malignancy, especially pancreatic, and even when the pain is not so intense, because this way the patient avoids then using large doses of opioid drugs and their side effects, ensuring better quality of life.