Evaluation of Trans-Aortic Oblique Fluoroscopic Tunnel Vision Approach of Celiac Plexus Block after Failure of the Classic Approach

Abstract

The conventional techniques of neurolytic celiac plexus block (NCBP) sometimes cannot be used in patients who have organomegaly, or not be able to tolerate the prone position necessary to place the needles; also anatomic anomalies may hinder obliquely placed needles from effectively reaching the target area. Complications such as organ puncture cannot be avoided with conventional techniques. The purpose of this study was to evaluate the safety and efficacy of a single needle transaortic celiac plexus block under an oblique tunnel view fluoroscopic guidance approach of celiac plexus alcohol block. Fifty patients with advanced upper abdominal cancer in whom the classic celiac plexus block failed were included in the study. A percutaneous single needle transaortic celiac plexus block under an oblique tunnel view fluoroscopic guidance was done at the level of middle L1 vertebra). Visual analog score, daily morphine consumption, duration of the procedure, adverse effects, and Quality of Life Questionnaire-QLQ-C30 were recorded. The mean visual analog score, daily morphine consumption significantly decreased and Quality of Life Questionnaire-C30 score significantly improved after the procedure. Conclusion: The percutaneous single needle transaortic celiac plexus block under an oblique tunnel view fluoroscopic guidance approach for celiac plexus block for upper abdominal cancer pain is proved to be safe and reliable and can be used as an alternative to the classic approach.