Classic transcrural celiac plexus block simulated on 100 computed tomography images

Area of Science:

• Interventional Radiology
• Pain Management
• Anatomy

Background:

• The transcrural celiac plexus block (tCPB) is a common procedure for managing abdominal pain.
• Understanding needle trajectories is crucial for procedural safety and efficacy.

Purpose of the Study:

• To evaluate the intra-abdominal needle trajectories of the classic tCPB using a simulation technique.
• To identify organs frequently traversed by the needle during tCPB.

Main Methods:

• Retrospective simulation of the classic tCPB technique on 100 abdominal CT images.
• Analysis of organ traversal by three simulated needle trajectories.
• Comparison of simulated organ penetration frequencies with existing literature.

Main Results:

• All simulated needle trajectories traversed various organs.
• The right-sided line frequently traversed the right kidney (36%).
• The left-sided line consistently traversed the aorta (100%).
• The modified right-sided line traversed the inferior vena cava (32%).
• Pancreatic cancer patients showed the highest kidney and aorta traverse percentages.

Conclusions:

• Classic tCPB needle placement frequently penetrates key abdominal organs, despite low reported clinical complications.
• Modifying needle trajectories can potentially avoid organ penetrations.
• Simulation provides valuable insights into procedural risks.