• - Pain due to neoplastic infiltration of celiac ganglia (pancreas, stomach tumour)
• - Preventive neurolysis in case of high risk of retroperitoneal neoplastic infiltration
• - Chronic pancreatitis (less efficient)

Target: Splanchnic nerves, in paravertebral anterior third position at the level of Th12, behind the crus of diaphragm

Procedure:

• POSTERIOR APPROACH:
• - Patient in prone position with i.v. drip
• - Axial scan from Th11 to L2 after i.v. contrast injection
• - Determination of target slice
  - Posterior paramedian approach
  - CT fluoroscopy-guided direct bilateral puncture from skin to splanchnic nerves with 22 gauge needles
• - Injection of 1mL of contrast media mixed with lignocaine (25/75%) on each side to prove extravascular position of needle tip and evaluate diffusion
• - Splanchnic nerve neurolysis with bilateral injection of 5mL of a 8% phenol in glycerine solution
  - Rinse needles with 1mL of lignocaine before withdrawal
• ANTERIOR APPROACH:
• (in combination with celiac neurolysis when posterior approach is impossible)
• - Patient in supine position
• - Axial scan from Th11 to L2
  - Transhepatic puncture (eventually transgastric) and para- or transaortic needle tip positioning at the anterior aspect of the Th12 vertebral body
  - Injection of 3 mL of contrast media mixed with lignocaine (25/75%) to prove extravascular position of needle tip and evaluate diffusion
  - Splanchnic nerve neurolysis with a single injection of 10 mL of a 8% phenol in glycerine solution
• - Rinse needle with 1 mL of lignocaine

Danger:

• - Avoid transpleural and transrenal puncture
  - Check diffusion and stop procedure if risk of spinal canal diffusion.
  

Complications:

• - Pain when crossing the diaphragm (96%)
• - Diarrhea (44%)
• - Orthostatic hypotension (38%)
• - Intense abdominal pain for some hours after neurolysis