SINGLE-NEEDLE CELIAC PLEXUS BLOCK - IS NEEDLE TIP POSITION CRITICAL IN PATIENTS WITH NO REGIONAL ANATOMIC DISTORTIONS

Background: The ''single-needle'' celiac plexus block is becoming a po pular technique. Despite different approaches and methods used to plac e the needle, the success of the block depends on adequate spread of t he injectate in the celiac area, In the present retrospective study, t he influence of needle tip position in relation to the celiac artery o n injectate spread was evaluated. Methods: Among 138 cancer patients s ubjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block, Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: uppe r right and left and lower right and left, as related to the celiac ar tery, Patient assessments by visual analog scale were reviewed to eval uate the degree of pain relief. Pain relief 30 days after block was ju dged as long-lasting, The patterns of contrast spread in relation to t he needle position and pain relief according to the number of quadrant s with contrast were analyzed, Results: The percentage of cases with f our quadrants with contrast was higher when the needle tip was cephala d (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P < 0.01), The percentage of patients with four and three quad rants with contrast was also higher in group B at 79% than in group A at 38% (P < 0.01), A significant difference in long-lasting pain relie f was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P < 0.01 ), No patients showing two or one quadrant with contrast had long-last ing pain relief, Conclusions: These findings suggest that, when the ce liac area is free from anatomic distortions, and the single-needle neu rolytic celiac plexus block technique is used, the needle tip should b e positioned cephalad to the celiac artery to achieve a wider neurolyt ic spread. It also appears that only a complete (four quadrants) neuro lytic spread in the celiac area can guarantee long-lasting analgesia.