Paraplegia after celiac plexus neurolysis in a patient with pancreatic cancer: A case report and literature review

A 65-year-old male patient underwent C-arm fluoroscopy-guided bilateral celiac plexus neurolysis to relieve peritoneal seeding-related pain associated with pancreatic cancer. Following confirmation of spreading, and no intravascular injection of contrast media, 7.5 ml of 0.25% chirocaine was injected in each side. The pain subsided after the block, with no motor or sensory deficits. Subsequently, celiac plexus neurolysis with 99.8% alcohol was performed using a posterolateral approach under fluoroscopic guidance. The patient was instructed to maintain a prone position for 2 hours while the procedure was performed. Approximately 4 hours later, the patient experienced paralysis of both lower extremities and hypoesthesia. Emergent magnetic resonance imaging of the thoracic and lumbar spine revealed gray matter signal change in the cord and conus medullaris at the T10-L1 level, and decreased perfusion at the T11-T12 vertebral bodies, suggesting spinal cord infarction. The patient remained paraplegic until his death 24 days later.

Radiation safety: a focus on lead aprons and thyroid shields in interventional pain management

C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.

How Effective Are Radiation Reducing Gloves in C-arm Fluoroscopy-guided Pain Interventions?

BACKGROUND: The physician's hands are close to the X-ray field in C-arm fluoroscopy-guided pain interventions. We prospectively investigated the radiation attenuation of Proguard RR-2 gloves. METHODS: In 100 cases, the effective doses (EDs) of two dosimeters without a radiation-reducing glove were collected. EDs from the two dosimeters-one dosimeter wrapped with a glove and the other dosimeter without a glove- were also measured at the side of the table (Group 1, 140 cases) and at a location 20 cm away from the side of the table (Group 2, 120 cases). Mean differences such as age, height, weight, radiation absorbed dose (RAD), exposure time, ED, and ratio of EDs were analyzed. RESULTS: In the EDs of two dosimeters without gloves, there were no significant differences (39.0 +/- 36.3 microSv vs. 38.8 +/- 36.4 microSv) (P = 0.578). The RAD (192.0 +/- 182.0 radcm2) in Group 2 was higher than that (132.3 +/- 103.5 radcm2) in Group 1 (P = 0.002). The ED (33.3 +/- 30.9 microSv) of the dosimeter without a glove in Group 1 was higher than that (12.3 +/- 8.8 microSv) in Group 2 (P < 0.001). The ED (24.4 +/- 22.4 microSv) of the dosimeter wrapped with a glove in Group 1 was higher than that (9.2 +/- 6.8 microSv) in Group 2 (P < 0.001). No significant differences were noted in the ratio of EDs (73.5 +/- 6.7% vs. 74.2 +/- 9.3%, P = 0.469) between Group 1 and Group 2. CONCLUSIONS: Proguard RR-2 gloves have a radiation attenuation effect of 25.8-26.5%. The radiation attenuation is not significantly different by intensity of scatter radiation or the different RADs of C-arm fluoroscopy.