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Celiac Plexus Blockade and Neurolysis: Fluoroscopy 

Celiac Plexus Blockade and Neurolysis: Fluoroscopy
Chapter:
Celiac Plexus Blockade and Neurolysis: Fluoroscopy
Author(s):

Imanuel R. Lerman

, Joseph Hung

, Dmitri Souzdalnitski

, Bruce Vrooman

, and Mihir Kamdar

DOI:
10.1093/med/9780199908004.003.0032
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date: 18 October 2019

Image-guided celiac plexus neurolysis can provide substantial and long-lasting pain relief in patients suffering from malignant pain from upper abdominal viscera. When performed by experienced hands, celiac plexus neurolysis also appears to be a relatively safe procedure with a limited side effect profile. Multiple imaging modalities are available for this procedure, though no single approach has systematically been proven superior in terms of efficacy or side effect profile. Each imaging guidance modality has advantages and disadvantages. Given the ability to visualize soft-tissue structures, CT guidance is recommended over fluoroscopy when intentionally transgressing into the retroperitoneum for celiac plexus neurolysis. It is also recommended in those patients with complicated anatomy, where anatomic distortion may complicate successful celiac blockade. However, in the patient without significant tumor burden involving the celiac axis and/or pancreatic body/tail, the fluoroscopy-guided retrocrural approach has been demonstrated to be efficacious, and complications are exceedingly rare.

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