Celiac plexus block

The needle is withdrawn, not through the skin, and reinserted at an increased angle of 5-10 degree to allow the tip to slide off the vertebral body anterolaterally.
• The needle is advanced approximately 1.5-2 cm past the original insertion depth.
• Aortic pulsations can be felt as they are transmitted along the needle when it is correctly placed.
• The procedure is repeated on the right side. Since aorta is not present on the right, the needle is advanced approximately 1 cm deeper on the right
• The needle is observed for leakage of blood, urine, or CSF.
• After careful aspiration, 5-10 ml of a diagnostic test dose containing 0.25 % bupivacaine with 1:200,000 epinephrine is injected through each needle.
• If the patient receives good pain relief from the test dose then a neurolytic block can be performed. 10-20 ml of 50-100% alcohol is injected slowly through each needle.
• The patient should be well hydrated and observed for a sufficient time after the block to ensure that postural hypotension is not a problem.
 
Brown, D.L. Regional Anesthesia and Analgesia. Philadelphia:  W.B. Saunders Company; 1996:375-380.
Miller. Anesthesia (5th edition). Churchill Livingstone, Inc.; 2000:1545-1546
DeLeon-Casasola. Critical Evaluation of Chemical Neurolysis of the Sympathetic Axis for Cancer Pain. Cancer Control. 2000; 7(2):142-148.
 
Radiographic guidance
• Fluoroscopy guidance
o Antero-posterior and lateral view on C arm portable fluoroscope helps to ascertain correct needle tip placement.
• CT scan
o CT-guided percutaneous neurolytic celiac plexus block (PNCPB) is a therapeutic modality in the treatment of refractory abdominal pain caused by cancer. 
o Bilateral multiple blocking of celiac plexus and splanchnic nerves is often required to achieve optimal analgesia.