The effect of celiac plexus block in critically ill patients intolerant of enteral nutrition: a randomized, placebo-controlled study.
BACKGROUND
In this study, we evaluated the efficacy of celiac plexus block for the treatment of feeding intolerance in critically ill patients.


METHODS
Nineteen mechanically ventilated medical patients intolerant of enteral nutrition and receiving metoclopramide underwent bilateral celiac plexus block. The anterior procedure was accomplished under sonographic guidance with the injection of either 25 mL bupivacaine 0.25% (celiac group, n = 10) or saline (control group, n = 9) bilaterally. Gastric emptying was assessed by the acetaminophen absorption method. After the block, nasogastric feeding was commenced, and nasogastric aspirates were collected once every 24 hours. Successful feeding was defined as 24-hourly gastric residual volume <250 mL with a feeding rate > or = 40 mL/h.


RESULTS
Demographic data were similar for the 2 groups. The area under the plasma paracetamol absorption curve (383.8 +/- 248.1 mg . min . L(-1)) and the peak plasma paracetamol concentration (C(max); 3.28 +/- 2.15 mg/L) in the celiac group were significantly lower than the area under the curve value (1233.5 +/- 771.2) and C(max) value (10.14 +/- 6.04) in controls (P < 0.001 for all). After treatment, celiac plexus block reduced the mean gastric residual volume (celiac group: 430 +/- 32 mL to 205 +/- 30 mL, P < 0.001; control group: 450 +/- 33 mL to 461 +/- 19 mL, P > 0.05) and improved the proportion of patients with successful feeding (celiac block 80% vs controls 0%, P < 0.001).


CONCLUSIONS
In critical illness, celiac plexus block is effective for treating feeding intolerance when IV drug therapy has failed to improve gastrointestinal dysfunction.
Memis
Dilek
D
Department of Anaesthesiology and Reanimation, Trakya University Medical Faculty, Edirne 22030, Turkey. dilmemis@mynet.com
Inal
Mehmet Turan
MT
Temizoz
Osman
O
Genchallac
Hakan
H
Ozdemir
Huseyin
H
Sut
Necdet
N
D018806:APACHE; D000082:Acetaminophen / Q000097:blood; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000097:blood; D000758:Anesthesia; D001786:Blood Glucose; D002447:Celiac Plexus; D003422:Critical Care; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D012121:Respiration, Artificial; D013270:Stomach / Q000033:anatomy & histology; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D001786:Blood Glucose; D000082:Acetaminophen