One needle transcrural celiac plexus block. Single shot or continuous technique, or both.

Abstract

The purpose of the study was to establish a one needle transcrural technique for the celiac plexus block in the lateral position. Contrary to the conventional prone bilateral approach, the lateral position with a cushion under the flank is better tolerated and makes bony landmarks more accessible. Unilateral needle placement reduces the morbidity of the technique and should also enable one to apply single administration or continuous blocks, or both. Primary anatomic studies on 20 corpses were performed. The needles were inserted anteromedially, on the left side, 4-6 cm lateral from the spinous process of L1 vertebral body, to reach the celiac plexus area at the level of the celiac axis, and 30 mL of methylene blue was injected. Autopsy revealed the needle tips placed preaortic or paraaortic and methylene blue covered the celiac plexus area bilaterally with a predominance on the left side. With the same technique, an epidural catheter was inserted via the needle and injected methylene blue covered the area of the plexus as well. This technique was further employed in the pain clinic, on 35 consecutive patients with pancreatic or gastric carcinoma, for diagnostic celiac plexus block and subsequent neurolysis for pain relief (70 celiac plexus blocks). The technique was employed in the first 10 cases with the aid of computed tomography and subsequently using only fluoroscopy. The effects were comparable to the other techniques of blocking the celiac plexus. Clinical results proved that the unilateral, transcrural technique in a lateral position is simple, safe, and gives a reliable celiac plexus block or neurolysis effects under fluoroscopy, or both, comparable to the results where computed tomography was used. The possibility of continuous block makes this technique useful in clinical practice.