Korean J Pain.  2015 Apr;28(2):109-115. 10.3344/kjp.2015.28.2.109.

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

• An JW
• Choi EK
• Park CH
• Choi JB
• Ko DK
• Lee YW

• KMID: 2278270
• DOI: http://doi.org/10.3344/kjp.2015.28.2.109

Abstract

BACKGROUND
This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB).
METHODS
CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a 10degrees bent tip needle under a 20degrees oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured.
RESULTS
The imaginary safe oblique angle range was 26.4-34.2degrees and 27.7-36.0degrees on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient.
CONCLUSIONS
We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a 20degrees oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.

Keyword

Bent tip needle; Celiac plexus block; Fluoroscopy; Retrocrural approach; Visceral pain

MeSH Terms

Celiac Plexus*
Fluoroscopy
Humans
Needles*
Punctures
Skin
Tomography, X-Ray Computed
Visceral Pain

Figure

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  Fig. 1 Transaxial CT abdomen images of L1 vertebral body at the level of celiac artery and at the uppermost level of the L2 vertebral body. A (A'), the anterolateral part of the L1 vertebral body crossed with a vertical line of the mid portion of the pedicle; B (B'), the upper anterolateral part of the L2 vertebral body crossing the vertical line of the mid portion of the pedicle, not to penetrate the crura; C (C'), the skin surface farthest from the midline to project tangentially to B while avoiding major abdominal organs; D (D'), the nearest skin surface to project tangentially to B while avoiding interference with osteophytes or lateral bony structures of the L2 vertebral body; E (E'), the skin surface crossing the vertical line of the mid portion of the pedicle; F: midline, Rt.: right, Lt.: left.

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  Fig. 2 X-ray fluoroscopy images ([A] Anteroposterior view, [B] Right oblique view, [C] Lateral view) of celiac plexus block by a posterior retrocrural approach that utilizes a 20° oblique angle. G (G'), the actual puncture site; F: midline, Rt.: right.

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