Korean J Pain.  2013 Oct;26(4):396-400. 10.3344/kjp.2013.26.4.396.

Computed Tomography (CT) Simulated Fluoroscopy-Guided Transdiscal Approach in Transcrural Celiac Plexus Block

• Kong YG
• Shin JW
• Leem JG
• Suh JH

• KMID: 2074050
• DOI: http://doi.org/10.3344/kjp.2013.26.4.396

Abstract

Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.

Keyword

celiac plexus block; CT simulated fluoroscopy-guided; transcrural approach; transdiscal approach

MeSH Terms

Aorta
Celiac Plexus
Humans
Intervertebral Disc
Kidney
Male
Middle Aged
Needles
Pancreatic Neoplasms
Spine

Figure

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  Fig. 1 The axial image of abdominal CT at the level T12 showing the celiac trunk. (A) The lines drawn according to the conventional transcrural approach was impeded by kidney in right side and aorta in left side. (B) Right needle pathway via transdiscal in transcrural approach was drawn on the image at the level T12-L1 intervertebra disc. I: the right needle insertion point, S: midline of spinous process, IS: 3.6 cm, *The angle for needle insertion on the right.

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  Fig. 2 Fluoroscopic views of needle location and contrast flow. (A) On an anteroposterior view, the contrast spread across the midline. (b) On the lateral view, the needle penetrated disc, and its tip is located approximately 2/3 of AP diameter anterior to vertebra body.

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