Abstract
Celiac plexus and splanchnic nerve blocks have been applied effectively to relieve pain in abdominal cancer or pancreatitis patients. However, several complications, such as pneumothorax and puncture of abdominal organs, have been reported. In the present study, we examined the radiographical anatomy around the celiac plexus in 37 prone positioned patients undergoing the blocks. CT scan images were obtained prior to the blocks in the prone position, and the positional relationship of the aorta, pleural space and vertebral body was examined at the level of the celiac artery base. The block needles were inserted under the guidance of fluorography. In 17 patients, the bottom of the right pleural space was located lower than that of the left one. The bottom of the pleural space was located at the level of the lumbar vertebral bodies (first or second) in 22 patients in the right side, and in 16 patients in the left side. In the 78% of patients, the celiac artery base was located at the level of the first lumbar vertebral body. In the 80% of patients, the left margin of aorta was located along or beyond the left tangential line of the vertebral body at the level of the celiac artery base. In all of the subjects, the blocks were effective in ameliorating intractable pain. No complication was caused by this block procedure. In conclusion, the position of organs surrounding celiac plexus in the prone position was different from that in the supine position. The use of CT in the prone position can effectively localize the organ positions prior to the nerve block, and enable safe and effective insertion of the needle under fluorographic guidance.
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