The thoracic splanchnic nerves are preganglionic sympathetic nerves formed from the thoracic sympathetic ganglia: the greater splanchnic nerve (T5-T9 or T5-T10), the lesser splanchnic nerve (T10-T11), and the least splanchnic nerve (T12). They pierce the crus of the diaphragm to reach the celiac and superior mesenteric ganglia where they synapse, providing sympathetic innervation to abdominal viscera.
The greater splanchnic nerve is the primary target for percutaneous or thoracoscopic splanchnicectomy for chronic pancreatic pain and intractable cancer pain. Thoracoscopic splanchnicectomy divides the greater (and often lesser) splanchnic nerve at T10 level, providing pain relief superior to celiac plexus block alone in some studies. The splanchnic nerves carry visceral pain afferents from the upper abdominal organs, explaining why pancreatic pain radiates to the back at the T10-T12 dermatomal level.
Division of the greater splanchnic nerve under thoracoscopic guidance at T10 level interrupts visceral pain transmission from the pancreas and upper abdominal organs in chronic pancreatitis and pancreatic cancer, providing significant pain reduction and opioid-sparing effect when percutaneous celiac plexus block has failed.
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