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

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.