Transaortic Celiac Plexus Block: A Computed Tomography Simulation Study

  Anesthesiology and Pain Medicine

  Ender Sir

Now published in Journal of Surgery and Medicine doi: 10.28982/josam.587699

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Abstract

Background and Purpose: Transaortic celiac plexus block is a traditional treatment method in chronic upper abdominal pain. Knowing the technique parameters before the procedure provides convenience to the physician during the block.For this purpose, we simulated the transaortic CPB with computed tomography (CT) and thus aimed to determine the main technical parameters and the risk of complications. Materials and Methods: We analyzed one hundred, transaxial, thin section, abdominopelvic CT images. We recorded morphological disturbances such as the presence of aortic mural calcification, thrombus,and aneurysm.We drew a needle insertion pathway on each of the images, at left, 7 cm away from the midline in the lumbar region. Subsequently, we recorded the penetrated organs, the needle entry angle, and the distance from the skin to the needle tip. Also, we measured the appropriate entry distance and angle for successful injection in patients that we could not provide transaortic access. Results: In the CT-simulated images, according to defined level and distance, we could reach the aorta in 73% of the patients. The mean needle entry angle and the distance from the entry point to the needle tip was 23.3 ± 3.2°, 15.25 ± 1.2 cm, respectively, and kidney penetration was 6.9%. We were able to access aorta in remaining 27% of patients with a mean distance of needle entry point from the midline, a mean needle entry angle, and a mean distance from the entry point to the needle tip, 10.08 ± 1.25 cm, 34.04 ± 5.43°, and 17.09 ± 1.32 cm, respectively. The kidney penetration rate was 44.4% in these patients. Conclusion: In the transaortic technique used for the celiac plexus block, successful aortic penetration is not always achieved. When the access angle and distance are increased, the aortic transition can be achieved, but the risk of organ injury significantly increases.

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