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Objective To investigate the effects of neurolytic celiac plexus block(NCPB) on stress response during the early stage of partial hepatectomy(PH) postoperation in rats.Methods Thirty healthy SPF-grade male Sprague-Dawley rats were randomly divided into control group and NCPB group,and then were constructed the 70％ PH model.NCPB group received NCPB with 0.5 ％ lidocaine before closing abdominal,and control group received the same procedures,but 0.9％ physiological saline was injected instead of 0.5 ％ lidocaine.The serum concentration of CRP,GC,ACTH,NA and AD,and the levels of serum TNF-α and IL-1β were determined at 6 hours,12 hours and 24 hours after PH.The western blot assay was performed to examine the expression of GR in the peripheral blood mononuclear cells (PBMCs).Results The obvious stress response was produced within 24 hours after PH in rats,postoperative serum CRP,GC,ACTH,NA and AD concentrations increased in the different extent,but the NCPB group were significantly lower than those in the control group in the corresponding time point (P ＜0.01 or P ＜0.05).The expression levels of GR in PBMCs in the control group were significantly decreased after PH,and markedly lower than those in the NCPB group in the corresponding time point(P ＜ 0.01).The serum TNF-o and IL-1β levels were gradually increased in the control group and NCPB group within 24 hours after PH.But at the respective time points,the levels in the NCPB group were significantly lower than those in control group(P ＜ 0.01 or P ＜ 0.05).Conclusion Intraoperation NCPB can effectively inhibit postoperative stress response at the early stage after PH,and thereby help to reduce the degree of systemic inflammatory response.
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BACKGROUND: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB). METHODS: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a 10degrees bent tip needle under a 20degrees oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured. RESULTS: The imaginary safe oblique angle range was 26.4-34.2degrees and 27.7-36.0degrees on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient. CONCLUSIONS: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a 20degrees oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.
Subject(s)
Humans , Celiac Plexus , Fluoroscopy , Needles , Punctures , Skin , Tomography, X-Ray Computed , Visceral PainABSTRACT
Objective: To analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: One hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: Aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: Considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject. .
Objetivo: Analisar variações anatômicas relacionadas ao bloqueio do plexo celíaco por meio da simulação por tomografia computadorizada e avaliar a possibilidade de transfixação de órgãos pelo método transcrural. Materiais e Métodos: Cento e oito imagens de tomografias computadorizadas transaxiais abdominais foram analisadas. As relações aorto-vertebral, tronco celíaco (TCe)-vertebral, TCe-aórtica e celíaco-aorto-vertebral foram registradas. Em cada imagem foram dispostas duas trajetórias de agulhas, a 9 cm e a 4,5 cm à esquerda e à direita da linha média. Os órgãos vitais transfixados e associações relacionadas ao gênero foram registrados. Resultados: Aorto-vertebral - 45,37% esquerda e 54,62% central; TCe-vertebral - T12, 36,11%; T12-L1, 32,4%; L1, 27,77%; T11-T12, 2,77%; TCe-aórtica - 53,7% esquerda e 46,3% central; celíaco-aorto-vertebral - L-l, 22,22%; M-m, 23,15%; L-m, 31,48%; M-l, 23,15%. Em nenhum dos critérios analisados houve correspondência no lado direito e nem associação significativa entre os gêneros. Conclusão: O bloqueio do plexo celíaco não deve ser padronizado, em razão das amplas variações anatômicas abdominais e das características próprias de cada acesso, sendo necessário o registro de imagem prévio ao procedimento para cada paciente, visando diminuir riscos de lesão. Registros sobre a variação anatômica quanto ao gênero, relacionados ao bloqueio do plexo celíaco, devem ser aprofundados. .
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Objective To investigate the effect of neurolytic celiac plexus block (NCPB) on the inflammatory reaction of the remaining liver tissue and liver function after partial hepatectomy (PH) in rats.Methods Thirty male Sprague-Dawley rats of SPF were constructed as a PH model with deligation and ablation operated on their left and middle lobes,respectively.Then,they were randomly divided into two groups:NCPB group and control group.Twelve hours after the surgery,0.5％ lidocaine was given in the NCPB group once a day,while 0.9％ saline was given in the control group.Determination of liver function,generation of the remaining liver,and deposition of IL-β,TNF-α of the pathological section was respectively made on Day 1,3 and 7 after the surgery.Results On Day 1,3 and 7 after surgery,both the aspartate aminotransferase (AST) and the alanine aminotransferase (ALT) levels in NCPB group were,to different degrees,lower than those in the control group (P ＜ 0.05).Strikingly,total bilirubin in NCPB group was lower than that in control group (P ＜ 0.01) on Day 7,while the level of semm albumin was higher than that in control group (P ＜ 0.01).There was no statistically significant difference on the generation of the remaining livers between NCPB and control groups.On Day 3 and 7,the deposition of IL-β,TNF-α in the pathological sections of NCPB group were lower than those in control group.Conclusion NCPB can not only effectively reduce the damage of liver function caused by PH surgery,but also improve the inflammatory reaction of the residual liver.
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Objective To evaluate the efficacy and safety of CT-guided percutaneous celiac plexus block (NCPB) using 25 G controllable curved needle together with 22 G straight needle in treating refractory carcinomatous upper abdominal pain. Methods A total of 18 patients with advanced refractory carcinomatous upper abdominal pain were enrolled in this study. The carcinomatous upper abdominal pain failed to the three-step analgesic therapy. Guided by CT scan, percutaneous injection of ethanol with a 25 G controllable curved needle to destroy celiac plexus was carried out in all patients. According to WHO pain relief standards, the relieving degree of pain was evaluated before NCPB and 2 weeks, one, 2, 3 and 6 months after NCPB. The results were analyzed. Results The technical success rate was 100%. The short-term (within 2 weeks) efficacy rate was 88.8%and the complete remission rate was 38.8%. The long-term (over 3 months) efficacy rate was 50% and the complete remission rate was 20%. No severe complications occurred. Conclusion For refractory carcinomatous upper abdominal pain, CT-guided percutaneous celiac plexus block is a simple, safe and effective treatment.
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Neurolytic celiac plexus block (NCPB) is an effective method used to alleviate upper abdominal pain or back pain caused by pancreatic cancer and other malignancies. NCPB can relieve cancer pain to improve the quality of life and cause fewer side effects than conventional analgesic drugs. This article systemically reviewed NCPB methodology and research progress in clinical appli-cations.
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Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.
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Humans , Male , Middle Aged , Aorta , Celiac Plexus , Intervertebral Disc , Kidney , Needles , Pancreatic Neoplasms , SpineABSTRACT
Abdominal pain associated with chronic pancreatitis is often difficult to control with analgesics and can be severely debilitating with significant impairment of quality of life. In these patients, neurolytic celiac plexus block (NCPB) is an effective treatment option with a low complication rate. However, there is a risk of ejaculatory failure after NCPB, which may be a problem in patients with a long life expectancy. We report a case of ejaculatory failure after unilateral NCPB in a patient with chronic pancreatitis.
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Humans , Abdominal Pain , Analgesics , Celiac Plexus , Life Expectancy , Pancreatitis, Chronic , Quality of LifeABSTRACT
A 61-year-old man who had cholangiocarcinoma with multiple metastasises was referred to our hospital for his pain control.Celiac plexus block with 99.9% alcohol was performed by the retrocrural approach under fluoroscopic guidance.Examination of the patient at fifteen minutes after successfully performing the diagnostic block showed no sensory or motor change.Forty-eight hours after the neurolysis, the patient's lower extremities were totally paralyzed, and he could not walk nor control his anal sphincter.But thereafter he progressively recovered.Five days after celiac plexus neurolysis, he was able to walk with support from one hand.Reversible ischemia of the spinal cord due to damage to the Adamkiewicz arterial blood supply was thought to be the cause.
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Humans , Middle Aged , Celiac Plexus , Cholangiocarcinoma , Ischemia , Lower Extremity , Neoplasm Metastasis , Paraplegia , Spinal CordABSTRACT
A 54-year-old man who had metastasis of gastric cancer was referred to pain clinic to control his severe epigastric pain.After the confirmation of the effect of the diagnostic celiac plexus block, c-arm-guided neurolysis of celiac plexus using alcohol was performed without any sensory or motor change.Five days after the chemical neurolysis, elevated hemidiaphragm and basal atelectasis of right lung were noted at routine chest X-ray follow-up without any respiratory symptoms such as dyspnea.There was no evidence of diaphragmatic metastasis. Two months after the neurolysis, the radiographic finding did not show any change.
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Humans , Middle Aged , Celiac Plexus , Follow-Up Studies , Lung , Neoplasm Metastasis , Nerve Block , Pain Clinics , Pulmonary Atelectasis , Respiratory Paralysis , Stomach Neoplasms , ThoraxABSTRACT
Gall bladder cancer is a very rare disease but most common in the biliary system. It has a poor prognosis because it is usually detected at an advanced stage due to no specific symptoms. So sometimes all that is needed is a proper pain control. It is important to remember that newly developed pain area can be a referred pain due to a cancer. We present a patient with a gall bladder cancer who suffered from right scapular and paravertebral pain. For his pain relief, we tried celiac plexus block and his pain was dramatically relieved.
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Humans , Biliary Tract , Celiac Plexus , Gallbladder Neoplasms , Pain, Referred , Prognosis , Rare DiseasesABSTRACT
A neurolytic celiac plexus block produces long-lasting pain relief in upper abdominal cancer patients. Unwanted side effects such as local pain, hypotension, and diarrhea are common but the durations of these side effects are usually transient. Chronic diarrhea induced by a neurolytic celiac plexus block is rarely reported and is considered to be an autonomic neuropathy due to sympathetic denervation. A 73-year-old Klatskin tumor patient developed chronic diarrhea after a neurolytic celiac plexus block and the diarrhea was sustained for 3 months despite the use of conventional antidiarrheal treatments. We report a case of chronic diarrhea that was induced by a neurolytic celiac plexus block.
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Aged , Humans , Celiac Plexus , Diarrhea , Hypotension , Klatskin Tumor , SympathectomyABSTRACT
The sympathetic nervous system has been implicated in the maintenance of numerous pain syndromes. Interruption of sympathetic pathways has been widely applied to relieve pain. Neurolytic sympathetic block is often well tolerated, because numbness and motor weakness are uncommon and neuritis rarely develops. The classic targets for sympatholysis are the stellate or cervicothoracic ganglion for facial and upper extremity pain, celiac plexus for abdominal pin, and lumbar sympathetic chain for lower extremity pain. In addition, the thoracic ganglion is occasionally blocked for the treatment of hyperhidrosis and of pain emanating from the pleura and esophagus. The recognition of the clinical utility of cervical epidural nerve block in the management of head, face, neck, shoulder, and upper extremity pain has brought the technique into the mainstream of contemporary pain management practice. Lumbar epidural nerve block has great utility in the management of a variety of acute, chronic, and cancer-related pain syndromes. The nerve root sleeve is particularly accessible to precise local anesthetic blocks. Segmental information gained from such nerve root blocks can be helpful in sorting out confusing patterns of referred pain to the limbs. The pathway for insertion of spinal needles must be planned so as to avoid damaging neural structures. Spinal nerve roots are particularly delicate structures and do not take kindly to being impaled.
Subject(s)
Celiac Plexus , Esophagus , Extremities , Ganglion Cysts , Head , Hyperhidrosis , Hypesthesia , Lower Extremity , Neck , Needles , Nerve Block , Neuritis , Pain Management , Pain, Referred , Pleura , Shoulder , Spinal Nerve Roots , Stellate Ganglion , Sympathetic Nervous System , Upper ExtremityABSTRACT
Objective:To validate the clinical value of CT-guided curve-needle percutaneous ethanol injection (CNPEI) for celiac plexus block analgesia. Methods: Thirty-two patients with end-stage cancer, including 13 complicated with extensive retroperitoneal lymph node enlargement and fusion, were enrolled in this study. All patients complained of refractory upper abdominal pain and had received narcotic analgesics and radiotherapy, but the analgesic effect was not good. CT-guided CNPEI was therefore prescribed. Results: The effective rates of CT-guided CNPEI were 100%, 100%, 96.9%, 90.6%, 87.5%, and 84.4% immediately,and at 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after treatment, respectively. All enlarged lymph nodes had obvious necrosis and became shrunk. Conclusion: Combined application of bilateral anterior and posterior diaphragmatic crura block and trans-lymph node block can produce good analgesic effects, and curve-needle puncture make the above technique simpler.
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Objective To evaluate the value of MR-guided neurolytic celiac plexus block(NCPB)for treatment of upper abdominal cancer pain.Methods 13 neurolytic celiac plexus blocks were carried out in 12 patients with severe upper abdominal pain caused by malignant tumors.The pain-relieving effect of the block was both evaluated using visual analogue scale(VAS) and analyzed statistically in all cases.Results The placement of the needle MR-guided was easy and accurate,the successful rate of the puncture was 92%.There were no severe complications.The pain before and after the procedure had obvious difference and the pain relief could last for a long time.Conclusion MR-guided NCPB is a simple and effective technique for treatment of upper abdominal cancer pain.