Celiac plexus block - Injectate spread and pain relief in patients with regional anatomic distortions

Background: The success of the neurolytic celiac plexus block, despite diff erent approaches and methods used, depends on adequate spread of the inject ate in the celiac area This retrospective study was conducted to evaluate t he patterns of alcohol spread and pain relief in patients with cancer or th erapy-related anatomic distortion of the celiac area. Methods: From 177 cancer patients who underwent computed tomography (CT)-gu ided single-needle neurolytic celiac plexus block via an anterior approach, a radiologist, blind to the aim of the study, retrospectively selected 105 patients with abnormal anatomy of the celiac area as judged by CT images o btained before the block. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into fo ur quadrants: upper right and left and lower right and left, as related to the celiac artery. Results were expressed as the number of quadrants into w hich contrast spread, i.e., four, three, two, or one quadrants with contras t. The patterns of contrast spread according to the number of quadrants wit h anatomic distortion were analyzed. Patient assessment by visual analog sc ale was reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was considered long-lasting Pain relief at 30 days after block was analyzed according to the number of quadrants with contrast. Results: Overall, four, three, two, and one quadrants with contrast were ob served in 9 (8%), 21 (20%), 49 (47%), and 26 (25%) patients, respectively. An inverse correlation was observed between the number of quadrants with an atomic distortion and the number of quadrants with contrast (P < 0.001). Lo ng-lasting pain relief was noticed in nine of nine patients (100%; 95% conf idence interval, 66-100) with contrast in four-quadrants, and in 10 of 21 p atients (48%; 95% confidence interval, 26-70) with contrast in 3 quadrants (P < 0.01). None of the 75 patients with contrast in two quadrants or one q uadrant experienced long-lasting pain relief. Conclusions: These findings suggest that, using the single-needle anterior approach, the neurolytic spread in the celiac area is highly hampered by th e regional anatomic alterations. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia, and that this picture may be obtained in a very limited fractio n of patients with regional anatomic alterations.