Abstract ID: A9
Abstract Title: A Modified Transcrural Celiac Plexus Block
Poster Type: Either
ABSTRACT BODY
A Modified Transcrural Celiac Plexus Block
Ian Y. Yang, MD, Saeed Oraee, MD
Department of Anesthesiology and Pain Medicine
Our Lady of Mercy Medical Center
Bronx-Lebanon Hospital Center, Bronx, New York
Background: Traditional teaching and practice of celiac plexus block has been described as using needle contact to L1 vertebral body and “walk off” technique to guide the block trajectory. The frequency of patient anatomic variance renders this technique inaccurate and may lead to complications when adopting the transcrural approach. We translate topographic information collected from preoperative CT images into procedural use to increase the accuracy of needle placement.
Methods: The preoperative abdominal CT with contrast is reviewed. The image cut at the level either superior or inferior to the transverse process of L1 vertebral body, whichever shows the celiac trunk better is collected. A horizontal line tangential to the posterior skin surface is drawn on the film. Two vertical lines tangential to the flank skin surface on both sides crossing the horizontal line are also drawn. The right and left intersection points are designated as R and L, respectively. The horizontal line is bisected at point S (the spinous process of L1), thus making it known as RSL. Two proposed needle trajectory lines are drawn targeting the base of celiac trunk between the L1 vertebral body and the right kidney, inferior vena cava on the right side (Nr), and between the left kidney and L1 vertebral body on the left side (Nl). Nr and Nl intersect RSL at the future needle entry points Er and El, respectively. The angles between RSL and Nl (Al) and between RSL and Nr (Ar) are measured and recorded for procedural use. The distances of RS, ErS; LS, ElS are measured, and the proportions of ErS/RS (Pr) and ElS/LS (Pl) are calculated for procedural reference.
During the procedure, the RSL is drawn on the back skin of the patient inferior or superior to the transverse process of L1 corresponding to the CT film reviewed. It is confirmed by fluoroscopy. The distance between RS and LS is measured. The location of points Er and El are determined by ErS = RS × Pr and ElS = LS × Pl, respectively. They are marked on the line RSL. The needles are inserted at entry points Er and El along the transverse plane with angles Ar and Al determined previously. The angles are measured by a sterile protractor. The depth of needle insertion is determined by frequent fluoroscopy, and the endpoint is determined by fluoroscopy with contrast when adequate depth is reached.
Results: Seven patients requiring the block have undergone the procedure with this modified approach. We have experienced a higher success ratio with no painful needle contact to vertebral body, less needle insertion times, and no great vessel piercing.
Conclusion: Although preprocedural CT film collecting and reviewing is time consuming, shortening of actual procedure time and reduction of complications warrant these modifications.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A9