Transcrural coeliac plexus block simulated on 200 computed tomography images.

Abstract

We previously reported a modified transcrural coeliac plexus block (tCPB) case, using parameters obtained from a pre-procedural computed tomography (CT) image of that patient for the subsequent tCPB under fluoroscopy. In this study, we performed the same tCPB simulation on 200 CT images to determine optimal needle placement parameters with a comparison to the classic technique. On each CT image across the coeliac trunk, the tCPB was simulated on both sides with the needle trajectory placed between the vertebra and organs targeting the coeliac trunk. The distances of the needle entrance from the midline, the insertion angles, and depths were measured and analysed in the groups: laterality, gender, intra-abdominal condition, and coeliac-aortic-vertebral (c-a-v) distribution. Thirty placements failed to avoid organ penetration. The left-sided placements required a shorter distance, 3.58 (1.02) cm, with a steeper angle, 84.1° (6.0°), than those for the right placements [7.04 (1.56) cm, 61.1° (6.2°)] (P<0.00001). The shortest distances, 3.1 (0.8) cm, with the steepest angles, 87.7° (4.5°), were seen in the patients whose c-a-v distributions were left-left located (P<0.00001). Males required longer distance for needle insertion (P≤0.05). Cancer patients required a shorter distance with a steeper angle for the right needle placements (P<0.05). Needle placement parameters for tCPB vary in laterality, gender, pathologies, and c-a-v distributions. We would advocate a simulated block on individual patient's CT image to obtain relevant measurements for subsequent tCPB, although a clinical outcome study is warranted.