The greater splanchnic nerve is formed by preganglionic sympathetic fibres from the fifth to ninth thoracic sympathetic ganglia (T5-T9). It descends obliquely on the anterolateral surface of the vertebral column, pierces the diaphragmatic crus, and synapses in the celiac ganglion. It conveys sympathetic innervation to the foregut and midgut (stomach to transverse colon, liver, spleen, pancreas) and is the primary pathway for visceral pain from the upper abdominal organs.
| Origin | Thoracic sympathetic ganglia T5-T9 (preganglionic fibres) |
|---|---|
| Course | Descends obliquely on the thoracic vertebral bodies, pierces the crus of the diaphragm, and ends mainly in the celiac ganglion, with some fibres to the aorticorenal ganglion and adrenal medulla |
| Sensory |
|
The greater splanchnic nerve is the primary pain pathway for chronic upper abdominal visceral pain, particularly from pancreatic cancer and chronic pancreatitis. Splanchnic nerve neurolysis using alcohol or radiofrequency ablation, targeting the nerve as it passes through the diaphragmatic crura, is an effective alternative to celiac plexus block for pain management in pancreatic malignancy. The procedure can be performed endoscopically, percutaneously under CT guidance, or thoracoscopically.
Chemical neurolysis of the greater and lesser splanchnic nerves at the diaphragmatic crura, performed percutaneously under CT guidance or thoracoscopically, provides effective pain relief for pancreatic cancer and chronic pancreatitis, with potential complications of orthostatic hypotension and diarrhoea from sympatholysis.
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