Neurolytic Celiac Plexus Block

Abstract

Associate Professor of Anesthesiology, Albert Einstein College of Medicine, Attending Anesthesiologist, Montefiore Medical Center, Bronx, New York 10467.In Reply:--Our patient did not experience paraplegia but aortic dissection, which caused visceral infarct, leading to sepsis and the patient's demise.Brown and Moore [1]reported two cases of pneumothorax in 136 patients and no permanent neurologic or other complications. They state that the expected incidence of neurologic complications should be less than 1% but provide no reference to indicate how that was determined.Lieberman and Waldman [2]did not report paraplegia as a complication in 124 patients. They referenced the complications of retroperitoneal hematomas (0.1–0.5%) for the transaortic technique specifically and paraplegia (1%) for celiac blocks in general. Although they cite a reference for the approximately 1% stated incidence of paraplegia, that reference does not indicate exactly how this figure was derived, but it appears that it was obtained by combining two case reports of paraplegia to approximately 400 patients they summarized from reported series in the literature. In addition to being an illegitimate means for determining the incidence of an event, none of the 400 patients from the summarized cases were reported to have paraplegia as an adverse event.Eisenberg et al. [3]quote a 1% incidence of neurologic complications, defined as lower extremity weakness, paresthesia, epidural anesthesia, and lumbar puncture. Eight of 268 patients experienced one (or more?) of these complications. It is therefore difficult to know the incidence for any particular complication, and paraplegia specifically was not listed.While a Medline search revealed no complications from celiac neurolysis when computed tomography (CT) was used, this cannot be interpreted that there are none. It can mean only that none have been reported. For example, Brown and Moore [1]provide