Search

Summary Coeliac plexus block, an established method of treatment for pain associated with pancreatitis and cancer, was used in neurosurgical patients with gastrointestinal dysfunction. The study was performed in 16 patients whose gastric reflux volume exceeded 600 ml per day for 3 consecutive days. Patients were allocated to a block group (n = 8) or a control group (n = 8). Coeliac plexus block was accomplished with a modified Moore technique using 50 ml bupivacaine 0.25%. In the block group, gastric reflux volumes for 3 days preceding coeliac plexus block and 3 consecutive days following coeliac plexus block were analysed. In the control group, gastric reflux volumes were observed over a period of 6 days. Mean (Sem) gastric reflux volume decreased significantly following coeliac plexus block from 770 (50) ml to 60 (30) ml (p > 0.01). In the control group, gastric reflux remained unchanged over the corresponding periods (730 (60) ml c.f. 670 (50) ml). The response of gastric reflux volume to coeliac plexus block suggests that the mechanism is related to inhibition of sympathetic activity in patients whose sympathetic drive is increased due to the underlying neurological disease, and possibly due to sedation withdrawal symptoms.

Conventional treatment of elevated intracranial pressure (ICP) includes various medications and physical measures of proven merit. Timely intubation and moderate hyperventilation, accompanied by adequate sedation and relaxation might certainly be mentioned as a first step in dealing with critical patients. Further important measures which have become established in clinical routine include raising of the head of the patient’s bed, intermittent osmotherapy and various types of medications.