Interventional pain · London
Coeliac plexus block, for real pancreatic pain relief.
A day-case block of the upper abdominal sympathetic nerves - done by a specialist pain consultant or EUS endoscopist, with palliative care integration, and either a CT-guided posterior or EUS-guided anterior route matched to your anatomy.
Why patients choose us
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A specialist pain physician or EUS endoscopist
Not a general list. A named interventional pain consultant or therapeutic EUS endoscopist with a high volume of coeliac plexus work.
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The right route for your case
Percutaneous CT-guided posterior, or EUS-guided anterior. We match the technique to your anatomy, coagulation status and disease stage.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private coeliac plexus block costs in London.
Indicative ranges across our partner units. Send the referral and imaging and we quote firm figures across two or three options, usually within a working day.
In short
A neurolytic block in our London network: £3,500–£8,500, home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation and imaging review | £300–£550 | 30–45 min | Same visit |
| Diagnostic coeliac plexus block (LA + steroid) | £2,400–£4,500 | 30–45 min | Same visit |
| Percutaneous CT-guided neurolytic block | £3,500–£6,500 | 45–60 min | Same visit |
| EUS-guided coeliac plexus neurolysis (EUS-CPN) | £5,500–£8,500 | 60–90 min | Same visit |
| Repeat neurolytic block at 3–6 months | £3,000–£6,000 | 45–60 min | Same visit |
| Second-opinion review of pain plan | £250–£450 | 30 min | 48 hours |
Prices vary by unit, by which consultant does the case, by whether anaesthetist-delivered sedation is used, and by whether EUS is required. We come back with a firm quote within one working day.
The problem
Pancreatic pain that opioids alone will not settle.
Rising opioid doses that bring nausea, constipation and cognitive fog without touching the pain. A coeliac plexus block interrupts the sympathetic pathway itself - often letting you step opioids down.
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Is the block even right for you?
Pain that is somatic, bony or neuropathic will not respond. We confirm the pain fits the coeliac territory before booking a procedure.
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Worried about paraplegia?
Rare, under 1 per cent in modern series. Reviewed on a named-consultant basis before you consent, with the EUS route offered where anatomy makes a percutaneous approach risky.
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Want palliative care integrated?
A block on its own is not a plan. We arrange the procedure with palliative care follow-up so the opioid step-down actually happens.
The journey
From referral to opioid step-down - what happens, in order.
One team from first message to the two-week pain review - including palliative care coordination and any repeat block at three to six months.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You send us the referral and imaging
A short, confidential form. Diagnosis, current opioid dose, coagulation, prior imaging (MRI or CT staging), and any prior blocks.
- 02
Before
We come back with a recommendation
Within one working day: percutaneous versus EUS, diagnostic block first or straight to neurolysis, indicative price and named consultant.
- 03
Before
We arrange the procedure
Usually within one to two weeks. Anticoagulants are reviewed, cross-sectional imaging is checked for vascular anatomy, and pre-procedure fluids are planned.
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On the day
Arrival at the unit
Arrival, consent and a chat with the interventionist and anaesthetist. IV fluid loading before the block to blunt post-sympathectomy hypotension.
- 05
On the day
The block itself
30 to 60 minutes. Prone for percutaneous CT-guided; left lateral for EUS-guided. Diagnostic local anaesthetic and steroid, or neurolytic ethanol or phenol.
- 06
On the day
Observation, then home
Two to four hours of observation for blood pressure and pain response. Home the same day for most, overnight admission for frail or symptomatic patients.
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After
Pain diary and opioid review
A structured pain diary over the first two weeks. Palliative care or your oncologist reviews opioid dose - most patients are able to step down.
Typical end-to-end: 1–2 weeks to procedure. Analgesia duration: 3–6 months. Repeat block: safe when needed.
When it helps
When a coeliac block is the right step - and when it is not.
The presentations we see most, plus the pain patterns that mean a coeliac block will not work and a different intervention is offered instead.
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Pancreatic cancer pain
Upper abdominal or mid-back pain from unresectable pancreatic cancer - the strongest indication, with 70 to 80 per cent of patients gaining meaningful relief and lower opioid needs.
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Chronic pancreatitis pain
Persistent visceral pain despite optimised medical treatment. Neurolysis is used with more caution here as pain often returns sooner and the disease is benign.
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Upper abdominal visceral cancer pain
Cancers of the stomach, distal oesophagus, biliary tree, liver, gallbladder and proximal small bowel that share the coeliac sympathetic pathway.
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Opioid-limiting side effects
Nausea, sedation, constipation or cognitive fog on rising opioid doses - a successful block often allows a real dose reduction.
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Recurrent pain after a previous block
Duration is typically three to six months. Repeat blocks are safe and often effective when pain returns.
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Anticoagulated or fragile patients
EUS-guided neurolysis avoids the retroperitoneal needle path and offers better vessel visualisation - useful when bleeding risk is higher.
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Not right: pain from bone metastases
Bone or somatic pain does not travel through the coeliac plexus. We refer to radiotherapy, bisphosphonates or targeted somatic blocks instead.
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Red flag: cord compression, sepsis, coagulopathy
New neurological signs, uncontrolled infection or uncorrected coagulopathy need urgent assessment before any block. Two-week-wait routes, not a private list.
Procedure options
Two routes to the same plexus, and the alternatives beside them.
What each option on the table actually involves - and which fits which patient. Where a coeliac block is not enough, we set out the next steps: superior hypogastric plexus block, stellate ganglion block, or intrathecal drug pump.
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Percutaneous CT-guided posterior block
Prone position, two needles placed bilaterally at T12 or L1 under CT or fluoroscopy. Contrast confirms spread; local anaesthetic and steroid, or 50 to 100 per cent ethanol, is injected.
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EUS-guided coeliac plexus neurolysis (EUS-CPN)
A linear echoendoscope from the stomach visualises the coeliac trunk. A fine needle delivers ethanol either into the plexus or around the coeliac ganglia. Anterior approach, no retroperitoneal path.
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Diagnostic block first
A trial injection of bupivacaine with or without steroid confirms that pain travels through the coeliac plexus. A clear response predicts a good outcome from neurolysis.
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Neurolytic block
A permanent chemical block using 50 to 100 per cent ethanol or 6 per cent aqueous phenol. Duration is typically three to six months - repeated when needed.
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EUS-guided coeliac ganglia neurolysis
Direct injection into individually visualised ganglia rather than a plexus spread. Some data suggest better and longer analgesia in selected pancreatic cancer patients.
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Splanchnic nerve block
A block at the T11 or T12 splanchnic nerves, above the diaphragm - an alternative when distorted retroperitoneal anatomy makes a coeliac block difficult.
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Superior hypogastric plexus block
For pelvic visceral pain, not upper abdominal. Complementary to the coeliac plexus block where cancer involves both territories.
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Intrathecal drug pump
For refractory pain when repeated neurolytic blocks lose effect - a small implanted pump delivers low-dose opioids and adjuvants directly to the spinal fluid.
Our vetted London network
A small panel of interventional pain consultants, we picked them.
Consultants working at Royal Marsden Private Palliative, King's College Hospital Private Pain, HCA The Wellington Pain Management, Cleveland Clinic London, London Bridge Hospital and Imperial Private. Introductions are private, once we understand your case.
Selection criteria
How we choose every consultant in our network.
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Interventional pain consultants with dedicated coeliac plexus lists, not occasional cases
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Therapeutic EUS endoscopists with EUS-CPN case volumes above published minimums
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Anaesthetic cover with arterial-line monitoring and IV fluid loading protocols
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Palliative care integration for opioid rotation and structured pain follow-up
Safety and recovery
What to expect afterwards - honestly.
A coeliac plexus block is a well-established pain intervention with strong evidence in pancreatic cancer (Wong et al., JAMA). The things worth planning are sedation, the transient blood-pressure drop, the two-week pain diary and the opioid step-down.
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Sedation or light general anaesthetic
Percutaneous blocks are usually under sedation with local anaesthetic infiltration. EUS-CPN uses propofol or a light general anaesthetic delivered by an anaesthetist.
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Post-block hypotension
Sympathectomy drops blood pressure in a large minority. Pre-procedure IV fluids and a short observation period manage this - most patients need nothing more.
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Transient diarrhoea
Unopposed parasympathetic tone can cause loose stools for a few days to a week. Loperamide is safe and effective. Rarely persistent.
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Local pain and back ache
A short flare of localised back or abdominal pain for 24 to 72 hours is common after ethanol neurolysis and settles with simple analgesia.
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Rare paraplegia
Injury to the artery of Adamkiewicz can cause spinal cord ischaemia and paraplegia - under 1 per cent in modern series. Reviewed and consented before the procedure.
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Rare visceral or vascular injury
Pneumothorax, retroperitoneal haematoma, pancreatitis and rare abscess formation. EUS-guided routes reduce vascular and pleural risk.
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Duration is three to six months
A good neurolytic block gives meaningful analgesia for a median of three to six months, sometimes longer. Repeat blocks are safe when pain returns.
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Not a cure for the disease
A coeliac plexus block treats pain. It does not treat pancreatic cancer or chronic pancreatitis - oncological and surgical plans continue in parallel.
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Red flags after discharge
New leg weakness or numbness, severe back pain, fever, breathlessness, or fainting - call the unit or go to A&E the same day.
Reading your procedure notes
Your block report in four parts. Read the last one first.
Whichever route was used, the report the consultant sends you keeps to the same shape.
A quiet reminder
Interventional pain language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report and the opioid taper before your review, just ask.
- 01 Header
Indication, approach and needle position
Diagnosis, pain territory, the route used (percutaneous CT-guided posterior or EUS-guided anterior), needle tip positions and contrast spread.
- 02 Technique
Agent, volume and confirmation
Local anaesthetic and steroid dose, or ethanol or phenol concentration and volume. Whether spread was pre-aortic, retrocrural, or into individual ganglia.
- 03 Findings
Complications and immediate response
Any hypotension managed, transient neurological symptoms, and the patient-reported pain score before and after the block on the recovery unit.
- 04 Impression
Opioid plan and follow-up interval
Read this first: a suggested opioid taper, the pain diary plan, when to contact palliative care, and when a repeat block should be considered.
Recognised by major UK insurers
Cover for coeliac plexus block varies by insurer and by indication - usually funded for cancer pain when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about coeliac plexus blocks.
Quick answers on route, duration, opioid reduction, and the rare risks worth understanding before you consent.
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What is a coeliac plexus block and how does it help pancreatic pain?
The coeliac plexus is a bundle of sympathetic nerves in the upper abdomen (T5 to T12 splanchnic fibres) that carry pain signals from the pancreas, liver, stomach and biliary tree. A block interrupts those signals with local anaesthetic and steroid, or destroys them with ethanol or phenol (neurolysis). In pancreatic cancer, 70 to 80 per cent of patients experience meaningful relief and are usually able to reduce their opioid dose.
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Percutaneous or EUS-guided - which is better?
Both work. Percutaneous CT-guided posterior blocks are well established and widely available. EUS-guided coeliac plexus neurolysis is an anterior route through the stomach wall, which avoids the retroperitoneal needle path and gives better vessel visualisation - useful for patients on anticoagulation or with distorted anatomy. Efficacy is broadly similar; the choice depends on your anatomy, coagulation status and the local expertise.
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How much does a private coeliac plexus block cost in the UK?
A diagnostic block with local anaesthetic and steroid is roughly £2,400 to £4,500. A percutaneous neurolytic block is £3,500 to £6,500. EUS-guided coeliac plexus neurolysis, which includes the endoscopy, is £5,500 to £8,500. A second-opinion review of your pain plan is £250 to £450. We confirm a firm figure within one working day.
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Will I be asleep for the procedure?
Percutaneous blocks are usually done under conscious sedation with local anaesthetic infiltration - you are drowsy and comfortable but breathing on your own. EUS-guided neurolysis is done under propofol sedation or a light general anaesthetic delivered by an anaesthetist, because a long endoscope is used.
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How long does the pain relief last, and can the block be repeated?
A neurolytic coeliac plexus block gives meaningful analgesia for a median of three to six months, sometimes longer. A repeat block is safe and often effective when pain returns. In chronic pancreatitis the duration tends to be shorter and repeat procedures are used more selectively.
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What are the risks - and how common is paraplegia?
The commonest side effects are a transient drop in blood pressure and loose stools for a few days, both usually mild. A short back-pain flare after ethanol is normal. Serious complications - retroperitoneal haematoma, pneumothorax, pancreatitis - are uncommon. Paraplegia from injury to the artery of Adamkiewicz is rare, under 1 per cent in modern series, and is discussed and consented before the procedure.
Talk to us today
Pancreatic pain does not have to run your day.
Send the referral and imaging. We come back within one working day with a named consultant, a route recommendation, and a firm price - including palliative care coordination.
Related treatments
Looking for something else?
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Superior hypogastric plexus block
For pelvic visceral cancer pain, below the coeliac territory.
Learn more -
Stellate ganglion block
A sympathetic block of the neck and upper chest.
Learn more -
Intrathecal drug pump
Refractory cancer pain when repeated blocks lose effect.
Learn more -
Pancreatic cancer treatment
The full private treatment pathway for pancreatic cancer.
Learn more -
Chronic pancreatitis
The condition page - symptoms, work-up and treatment.
Learn more -
Pancreatic cancer
The condition page - staging, symptoms and options.
Learn more