[Image-guided plexus and peripheral nerve blocks in modern multimodal pain management].

Abstract

Clinical/methodical issue: Chronic pain syndromes represent a major medical and socioeconomic burden. In both cancer-related and noncancer pain, pharmacological treatment alone is often insufficient or limited by adverse effects, particularly during long-term opioid therapy. Image-guided interventional procedures are therefore increasingly relevant as targeted, opioid-sparing components of multimodal pain management.

Imaging guidance and interventional techniques: This narrative review summarizes diagnostic blocks, therapeutic injections, and neurolytic procedures targeting sympathetic plexuses and peripheral nerves. It outlines the principal imaging modalities (computed tomography, fluoroscopy, ultrasound), common indications, and the distinction between diagnostic/prognostic, pharmacological, and definitive neurolytic techniques.

Evidence: Available evidence demonstrates clinically meaningful pain reduction, functional improvement, and opioid-sparing effects in selected indications. The strongest evidence exists for visceral cancer pain, particularly for celiac plexus and splanchnic nerve interventions, and for chronic musculoskeletal pain such as genicular nerve procedures.

Conclusion: Image-guided nerve and plexus interventions are effective components of multimodal pain management and can be integrated into interdisciplinary care pathways. Their clinical value depends on careful patient selection, precise anatomical targeting, standardized procedural quality, and structured outcome assessment; they should be considered early rather than only as a last-line option.