CT-guided neurolytic splanchnic nerve block with alcohol

Abstract

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.