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Computed Tomography (CT) Simulated Fluoroscopy-Guided Transdiscal Approach in Transcrural Celiac Plexus Block.

Yu Gyeong Kong¹, Jin Woo Shin, Jeong Gill Leem

¹Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

The Korean Journal of Pain

|October 25, 2013

Summary

A novel transdiscal approach offers a safer alternative for celiac plexus block (CPB). This technique avoids vital organ injury and achieves more complete injectate spread compared to conventional methods.

Keywords:

CT simulated fluoroscopy-guided celiac plexus block transcrural approach transdiscal approach

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Area of Science:

Interventional Radiology
Pain Management
Oncology

Background:

Conventional transcrural celiac plexus block (CPB) risks vital organ injury due to needle trajectory.
Limited injectate spread in conventional CPB can reduce efficacy for severe pain management.

Purpose of the Study:

To evaluate the safety and efficacy of a CT-simulated fluoroscopy-guided transdiscal approach for transcrural CPB.
To improve injectate spread and minimize complications in patients with pancreatic cancer pain.

Main Methods:

A CT-simulated fluoroscopy-guided transdiscal approach was developed targeting the T11-12 intervertebral disc.
Pre-procedural simulation determined optimal needle insertion point, angle, and depth.
The technique was applied to a patient with pancreatic cancer experiencing severe epigastric pain.

Main Results:

The conventional transcrural approach was impeded by anatomical structures (kidney, aorta).
The transdiscal approach allowed successful transcrural CPB with a single needle insertion.
Complete bilateral spread of injectate around the celiac plexus was achieved with the transdiscal method.

Conclusions:

The CT-simulated fluoroscopy-guided transdiscal approach provides a safer and more effective alternative for transcrural CPB.
This technique enhances injectate distribution and potentially improves pain relief in pancreatic cancer patients.
The transdiscal approach may obviate the need for a bilateral approach, simplifying the procedure.