CT-guided percutaneous neurolytic celiac plexus block technique

Abstract

Up to now, the studies in the world have demonstrated that CT-guided percutaneous neurolytic celiac plexus block (PNCPB) is an invaluable therapeutic modality in the treatment of refractory abdominal pain caused by cancer. Its efficacy of pain relief varied in reported studies. The main technical considerations which would affect the analgesic effects on abdominal pain included the patients' cooperation, needle entry approaches, combined use of blocking approaches, localization of the target area, dosage of the blocker, and so on. A success of PNCPB depends greatly on close cooperation with patients. The patient should be educated about the purpose and steps of the procedure, and trained of breathing in and breathing hold. The needle entry can be divided into the posterior approach and the anterior approach. The former one is the most commonly used in clinical practice, but the latter one is rarely used except in the cases that the posterior approach becomes technically difficult. Bilateral multiple blocking of celiac plexus and splanchnic nerves is often required to achieve optimal analgesia. The needle entry site, insertion course, and depth should be preselected and simulated on CT monitor prior to the procedure in order to ensure an accurate and safe celiac plexus block. The magnitude of analgesic effect is closely related to the degree of degeneration and necrosis of the celiac plexus. Maximally filling with blocker in the retropancreatic space is an indication of sufficient blocking. We also provided an overview of indications and contraindications, preoperative preparations, complications and its treatment of PNCPB.

Coeliac plexus neurolysis for upper abdominal malignancies using an anterior approach: review of the literature

“…19 At concentrations above 50%, the degree of destruction depends more on the distribution of ethanol within the coeliac plexus than its concentration. 19 Few authors recommend adding a longacting local anaesthetic such as bupivacaine to ethanol as its injection may cause severe transient pain. 18,19 Iodinated contrast material is another component that is added to ethanol to help visualise the distribution of neurolytic agent in the pre-aortic space.…”

“…19 Few authors recommend adding a longacting local anaesthetic such as bupivacaine to ethanol as its injection may cause severe transient pain. 18,19 Iodinated contrast material is another component that is added to ethanol to help visualise the distribution of neurolytic agent in the pre-aortic space. 18,19 A cocktail of absolute alcohol (95-100%), bupivacaine and contrast material, with a ratio of 6:3:1, is the most frequently used neurolytic mixture.…”

“…Ethanol causes immediate precipitation of endoneural lipoproteins and mucoproteins within the coeliac plexus, leading to extraction of cholesterol, phospholipid, and cerebroside from the neurilemma. 18,19 Irreversible damage to neurons and nerve fibres occurs at an ethanol concentration of more than 50%; hence, a concentration between 50% and 100% is preferred for coeliac plexus neurolysis. 19 At concentrations above 50%, the degree of destruction depends more on the distribution of ethanol within the coeliac plexus than its concentration.…”

“…18,19 Irreversible damage to neurons and nerve fibres occurs at an ethanol concentration of more than 50%; hence, a concentration between 50% and 100% is preferred for coeliac plexus neurolysis. 19 At concentrations above 50%, the degree of destruction depends more on the distribution of ethanol within the coeliac plexus than its concentration. 19 Few authors recommend adding a longacting local anaesthetic such as bupivacaine to ethanol as its injection may cause severe transient pain.…”

“…18,19 Iodinated contrast material is another component that is added to ethanol to help visualise the distribution of neurolytic agent in the pre-aortic space. 18,19 A cocktail of absolute alcohol (95-100%), bupivacaine and contrast material, with a ratio of 6:3:1, is the most frequently used neurolytic mixture. 20 Phenol has a somewhat slower onset and shorter duration of action and is less effective than ethanol.…”