Over a 3-year period, neurolytic abdominal visceral sympathectomy was performed bilaterally with 15 ml of alcohol solution (14 ml of alcohol and 1 ml of contrast material) through each needle under CT guidance to relieve upper abdominal or back pain in 27 cancer patients. Using the CT monitor, our intention was to achieve splanchnic nerve neurolysis rather than celiac plexus neurolysis. After determining the trajectory for needle placement on the CT image at the L1 level, the needles were inserted bilaterally with a simple guide apparatus. The needle tips were successfully positioned in the retrocrural space in 48 (83%) of 54 insertions. Pain was substantially relieved in 20 of 21 patients receiving bilateral splanchnic nerve neurolysis. Tissue pressure was significantly higher after alcohol injection when the needle tips were located in the retrocrural space than when they were placed in the anterocrural space. CT images after alcohol injection revealed antero- and posterocrural spread in 11 of 21 patients who received bilateral splanchnic nerve neurolysis. It was speculated that the alcohol spread through the aortic hiatus or gaps of the diaphragmatic crura. No neurologic complications were encountered. It is concluded that CT guided alcohol splanchnic nerve neurolysis is an effective treatment for upper abdominal cancer pain, and that 15 ml of alcohol solution through each needle is enough for splanchnic nerve neurolysis.
"The first technique has the advantage of being easy to perform and no organ is in the way of finding the plexus and patient's position is suitable for the practitioner. The second technique has the advantages of not requiring X-ray and patient's suitable positioning (7, 10). Advantages of each technique can potentially be the disadvantages of the other one (12). "
[Show abstract][Hide abstract] ABSTRACT: Celiac and splanchnic plexus blocks are considered as terminal approaches for pain control in end stage pancreatic cancer. It may be done temporarily (using local anesthetics) or as a permanent act (using alcohol and/or phenol).
Like every other interventional procedure, celiac plexus block has its own potential complications and hazards among them pneumothorax and ARDS are very rare.
In this case report we present an end stage patient with adenocarcinoma of ampulla of Vater with involvement of both abdomen and thorax who presented with severe intractable abdominal pain.
Bilateral celiac plexus block in this patient resulted in left side pneumothorax and subsequent development of ARDS. We discuss the rare complications of celiac plexus block as well.
[Show abstract][Hide abstract] ABSTRACT: Theodosiadis P, Grosomanidis V, Touroutoglou N Neurolytic celiac plexus block (NCPB) is a useful technique for pain control in patients with intra-abdominal tumors or pain secondary to chronic pancreatitis that does not respond to other therapeutic modalities (not interventional). The anterior approach for NCPB has been considered a relatively safe approach, with a low rate of complications and little risk of neurologic injury secondary to the spread of a neurolytic agent. This is the first national case report of successful NCPB using the anterior approach under CT guidance.
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