Celiac plexus block: an anatomical study and simulation using computed tomography.
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.


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.


CONCLUSIONS
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.
MSc, Human Anatomy Professor, Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brazil.
Gabriela Augusta Mateus
GA
Pereira
PhDs, Human Anatomy Professors, Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brazil.
Paulo Tadeu Campos
PT
Lopes
PhDs, Human Anatomy Professors, Universidade Luterana do Brasil (Ulbra), Canoas, RS, Brazil.
Ana Maria Pujol Vieira
AM
Dos Santos
PhD, Human Anatomy Professor, Centro Universitário Univates, Lajeado, RS, Brazil.
Adriane
A
Pozzobon
MD, Radiologist, Fundação Serdil/Saint Pastous, Porto Alegre, RS, Brazil.
Rodrigo Dias
RD
Duarte
MDs, Undergraduates, Specialization Program, Radiology and Imaging Diagnosis, Fundação Serdil/Saint Pastous, Porto Alegre, RS, Brazil.
Alexandre da Silveira
Ada S
Cima
MDs, Undergraduates, Specialization Program, Radiology and Imaging Diagnosis, Fundação Serdil/Saint Pastous, Porto Alegre, RS, Brazil.
Ângela
Â
Massignan
Anatomy; Celiac plexus block; Computed tomography; Transcrural pathway