Transcrural coeliac plexus block simulated on 200 computed tomography images

Area of Science:

• Interventional Radiology
• Pain Management
• Anatomy

Background:

• Previous work established a modified transcrural coeliac plexus block (tCPB) using patient-specific CT parameters.
• This study aimed to refine tCPB needle placement by simulating the procedure on 200 CT images.

Purpose of the Study:

• To determine optimal needle placement parameters for tCPB.
• To compare simulated tCPB parameters with the classic technique.
• To identify variations in optimal parameters based on patient characteristics.

Main Methods:

• tCPB was simulated bilaterally on 200 CT images, targeting the coeliac trunk.
• Needle trajectory, entrance distance from midline, insertion angle, and depth were measured.
• Analysis considered laterality, gender, intra-abdominal conditions, and coeliac-aortic-vertebral (c-a-v) distribution.

Main Results:

• Left-sided tCPB required shorter distances and steeper angles than right-sided placements (P<0.00001).
• Left-left c-a-v distributions showed the shortest distances and steepest angles (P<0.00001).
• Male gender and cancer pathology influenced needle insertion parameters (P≤0.05).

Conclusions:

• tCPB needle placement parameters are influenced by laterality, gender, pathology, and c-a-v distribution.
• Simulating tCPB on individual patient CT scans is recommended for accurate measurements.
• Further clinical outcome studies are warranted to validate simulated findings.