Celiac plexus block: an anatomical study and simulation using computed tomography

Abstract

ObjectiveTo analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized.Materials and MethodsOne hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded.ResultsAortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed.ConclusionConsidering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject.

Effect of celiac plexus neurolysis for pain relief in patients with upper abdominal malignancy: A retrospective observational study and review of literature

“…The preoperative mean QOL was statistically comparable with day 1 post procedure and with 1, 2, 3, 4, 5 and 6 months. Initially, there was improved overall QOL of almost all cases.…”

“…The preganglionic sympathetic fibers of the celiac plexus are grouped into greater (T5–10), lesser (T10–11), and least (T12) splanchnic nerves, and the plexus also receives parasympathetic fibers from the celiac branch of the right vagus nerve. [ 5 ]…”

Transaortic celiac plexus block: A computed tomography simulation study

“…However, this rate was 44.4% in patients whom we could not reach the aorta by the classical approach and determined a more lateral entry point at the skin. In the CT simulation study of retrocrural CPB of 108 patients applied by Gabriela et al [11], renal injury rates were 0.92% at 4.5 cm, and 23.25% at 9 cm left from the midline. On the other hand, in the transaortic CPB study performed by Abbas et al [18], no kidney damage was observed in any patient.…”

“…There are very few studies on the radiographic anatomy of CPB in the literature [15,17]. Previous radiological studies of the CBP were related to conventional antecrural or retrocrural techniques [8,11]. To the best of our knowledge, this is the first CT simulation study for transaortic CPB.…”

“…In the literature, there are CT simulation studies made for this purpose. In light of the results obtained from these studies, new modifications are recommended for more successful injections and low complication rates [8,11].…”