Alternative Method of Retrocrural Approach during Celiac Plexus Block Using a Bent Tip Needle

Area of Science:

• Interventional Radiology
• Pain Management
• Anatomy

Background:

• Computed tomography (CT) scans were reviewed to establish safe parameters for celiac plexus block (CPB).
• The study aimed to define safe ranges for needle angle, skin entry point, and length.
• The utility of a bent tip needle in CPB was also evaluated.

Purpose of the Study:

• Determine safe oblique angles, skin entry points, and needle lengths for celiac plexus block (CPB).
• Evaluate the effectiveness of a bent tip needle in performing CPB.
• Correlate anatomical parameters with patient characteristics like BMI.

Main Methods:

• CT scans of 60 CPB patients were analyzed.
• Measurements included minimal/maximal oblique angles and midline-to-puncture distances using the L2 vertebral body.
• Three-dimensional measurements calculated imaginary needle trajectory distances; a bent tip needle's actual puncture site distance was also recorded.

Main Results:

• Identified safe imaginary oblique angle ranges (26.4-36.0°) and midline-to-puncture distances (6.1-7.6 cm).
• Needle trajectory distances ranged from 9.5-11.6 cm.
• Bent tip needle procedures resulted in smaller measured distances (5.0-6.5 cm), with parameters correlating to BMI, except for GF/G'F. Mild, transient complications were observed.

Conclusions:

• Established safe parameter values for straight needle celiac plexus block (CPB).
• A bent tip needle, used with 20° oblique fluoroscopy, enabled safe CPB with reduced parameter values.
• The findings contribute to optimizing CPB technique and safety.