Coeliac Plexus Block for Pain Management in a Case of Intractable Pain of Chronic Pancreatitis: A Case Report

Chronic pancreatitis is a progressive inflammatory disease of the pancreas, frequently seen in middle-aged chronic alcohol consumers. It is characterised by irreversible morphological changes, such as parenchymal atrophy, ductal dilatation, and calcifications, often resulting in persistent abdominal pain. While initial management is primarily conservative with analgesics and enzyme replacement, pain in some patients remains refractory, necessitating interventional approaches. One such technique is the coeliac plexus block, which disrupts the visceral afferent pain pathways. We report a case of a 50-year-old chronic alcoholic male from a resource-limited setting who presented with intractable epigastric pain radiating to the back, severely impacting his quality of life. Imaging revealed classic features of chronic pancreatitis, including pancreatic calcifications and ductal dilatation. Laboratory investigations confirmed elevated pancreatic enzymes and inflammatory markers. Despite optimal medical management, his pain remained uncontrolled. A fluoroscopy-guided posterior para-aortic coeliac plexus block was administered using a combination of 0.25% bupivacaine and triamcinolone. The patient experienced significant and sustained pain relief, with a Numerical Rating Scale (NRS) score reduction from 8/10 to 2/10. He was discharged in a stable condition and reported improved appetite and daily functioning during follow-up. This case emphasises the utility of fluoroscopic coeliac plexus block as a viable, safe, and effective intervention in the management of chronic pancreatitis-related pain, particularly when conventional therapy fails. The report also underscores the importance of selecting an appropriate technique based on clinical scenario, resource availability, and patient suitability