Indications:

• - 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: Celiac plexus : anterior aspect of aorta and inferior vena cava, at the level of the celiac trunk

Procedure:

POSTERIOR APPROACH

• - Patient in prone position with i.v. drip
  - Axial scan from Th11 to L2 after i.v. contrast media injection
  
• - Delineation of celiac plexus at the level of the celiac trunk
  - CT fluoroscopy-guided direct single sided puncture from skin to celiac plexus with a 22 gauge needle. Needle should progress in paravertebral space, adjacent or through the aorta. Needle tip should be placed at the anterior aspect of the aorta, just below the celiac trunk.
  - Injection of 3mL of contrast media mixed with lignocaine (25/75%) to prove extravascular position of needle tip and evaluate diffusion
  - Celiac plexus neurolysis with injection of 15mL of a 8% phenol in glycerine solution or 15mL of pure ethanol
  - Rinse needle with 1mL of lignocaine before withdrawal

ANTERIOR APPROACH (in combination with splanchnic nerve neurolysis)

• - Patient in supine position
  - Axial scan from Th11 to L2
  - After splanchnic nerve neurolysis, retrieve needle tip at the anterior aspect of the aorta and proceed to celiac neurolysis
  - Injection of 3 mL of contrast media mixed with lignocaine (25/75%) to prove extravascular position of needle tip and evaluate diffusion
  - Celiac plexus neurolysis with injection of 15 mL of a 8% phenol in glycerine solution or 15 mL of pure ethanol
  - Rinse needle with 1 mL of lignocaine before withdrawal
  

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