1. ONE NEEDLE TRANS-AORTIC AND RETROCRURAL NEUROLYTIC CELIAC PLEXUS BLOCK FOR SEVERE UPPER ABDOMINAL CANCER PAIN
V. Whizar-Lugo, F. Anzorena-Vallarino, R. Estrada-Coronado,
C. Solar-Labastida, C. Segovia-García, J. Saldaña-Huerta
Servicios Profesionales de Anestesiología y
Medicina del Dolor
Centro Médico del Noroeste
Tijuana BC, México

2. To determine the pre-crural and retro-crural neurolytic spread
One Needle,Trans-aortic and Retrocrural Celiac Plexus Neurolysis Aim of the study
To investigate the usefulness of a single needle injection for a pre-aortic and retrocrural CPN in opioid resistant cancer pain patients, who have anatomy distortion
To determine the pre-crural and retro-crural neurolytic spread
To determine side effects and complications of this technique

3. Anatomy and Neurolytic Agent Diffusion

4. Celiac plexus neurolysis techniques According with anatomical approaches
POSTERIOR APPROACH
Retrocrural, Trans-crural, and Trans-aortic
ANTERIOR APPROACH
Trans-gastric and Trans-hepatic

5. Celiac plexus neurolysis techniques
According with neddle placement
RETROCRURAL
Standard
Two needless with posterior approach
PRECRURAL
Posterior approach
Trans-aortic
Trans-crural
Anterior approach
Trans-hepatic
Trans-gastric
RETRO and PRECRURAL
One needle technique

7. R e s u l t s Analgesia (VAS) and % Opiod Reduction Patients
Type of cancer
Pain (VAS)
% opioid reduction
Follow-up No
Age
Sex
Initial
Final
Months 12
51.8
M 11 / F1
Pancreas
8.7±0.9
2.5±0.9
76.25%
1 - 12 2
50.5
M 1 / F1
Liver
8.0
2.0
97.5%
3 - 7 39
Gastric limphoma
9.0
77.5%
5 - 8
47.5
Stomach
95.0%
1 - 7
TOTAL 18
M 14 / 2
9.0±0.89
2.3±0.9
80.8%

8. Patients Pain (VAS) Cancer Follow-up
% opioid reduction
Follow-up No
Age
Sex
inicial
final
Months
Dead 1 58 M 10
Pancreas 85 4 - 2 70 8 50 6 + 3 F 9
Stomach 90 7 35
Gastric limphoma 5 42
100 53
Liver 95 62 37 55 43 11 51 12 39 80 13 48 14 52 15 16 17 59 18

9. C o m p l i c a t i o n s Minor Severe Local pain n= 5 (-%)
Transitory diarrhea
n= 4 (-%)
Arterial hypotension
n= 2 (-%)
Severe
none

10. ONE NEEDLE CELIAC PLEXUS NEUROLYSIS
TRANS-AORTIC AND RETROCRURAL
C o n c l u s i o n s
This technique is usefull in patients with opioid resistant/side effects upper abdominal cancer pain, who have anatomy distortion
It is a safe, and easy procedure
No neuro-vascular complications were seen
Satisfactory analgesia was achieved
Total opioid intake was reduced