Regional anesthesia for hepatic arterial embolization

Hepatic arterial embolization (HAE) has been utilized for treatment of unresectable primary and metastatic hepatic malignancies. While palliation results from this procedure, one of the major drawbacks to its use is the immediate short-term side effects, especially the right upper quadrant and epigastric pain experienced by all patients. High doses of intravenous narcotics have been used for pain control. The data on 18 patients who received a celiac plexus block immediately prior to 31 HAE procedures were compared with those on 19 control patients who underwent 42 HAE procedures without celiac plexus block. All patients who received a celiac plexus block had relief of pain without requiring intravenous analgesic both during the procedure and for the first 8 hours after HAE. These patients also subsequently received substantially lower dosages of analgesics than the control subjects. Two patients had transient hypotension due to the celiac plexus block, but no other complications occurred. It is recommended that patients undergoing HAE first receive a celiac plexus block for pain control.