الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Malignant tumors originated from pancreas, stomach and liver may cause abdomina pain which is unresponsive to large doses of narcotic analgesics and which considerably impairs the patients’ quality of life.Celiac plexus block (CPB) has been used as an adjunct therapy in such cases. Celiac plexus is situated retroperitoneally in paravertebral areolar tissue at anterolateral edge of the first lumbar vertebra on both sides. It lies posterior to the stomach and pancreas,anterior to the crura of diaghragm and the aorta where it envelopes the origins of the celiac artery.
It receives efferent fibers from splanchinc nerves bilaterally, and post-ganglionic fibers from upper lumbar sympathetic ganglion and terminal branches of both vagi. It receives afferent fibers of both sympathetic and parasympathetic from viscera (afferent viscera] nociceptive fibers). By blocking the celiac plexus, one can interrupt nociception and any sympathetically mediated pain from the viscera. The block is better to be under image intensifier. Guidance by fluoroscopy or CT scan must be used when injecting neurolytic solution (alcohol or phenol) to ensure correct needle placement. Many methods have been used to block the celiac plexus.
The block could be achieved from posterior approach (including classic retrocrural, transcrural, transaortic or transinterverfebral disk approaches) or anterior approach (including intraoperative celiac neurolysis or percutaneous anterior celiac neurolysis). Also an endoscopic ultrasound guided approach could be utilized. Also the left lateral approach could be used.
In the classic approach, the patient lies in the prone position with piliow under the abdomen to flatten lumbar lordosis. Identify first lumbar vertebra and 12th rib by palpation and/or imaging and marked. Shallow triangle obtained by connecting these points: the spine of the T12 and L1 with points 7-8 cm. Literal at the lower edges of the 12th ribs is that of isosceles triangle. The point of needle insertion is immediately cauded to the 12th rib , 7 to 7.5 cm lateral to the midline .The needles are inserted bilaterally and advanced at an angle of about 45 degrees from horizontal plane and at about 15 degrees cephaled until contact is made with the upper part of the L1 vertebral body .The needle is then withdrawn slightly and redirected laterally to walk-off the vertebral body 1 to 2 cm beyond the anterior margin of the vertebral body where occasionally aortic pulsation can be felt . On the right side the insertion point of the needle should be more lateral and the needle should be advanced 1-2cm deeper.
Complications of celiac plexus block include minor, moderate or major complication. The minor complications includ hypotension ,diarrhea ,pain ,metabolic and. Moderate complications include visceral injury and minor neurological complications . Major complication is paraplegia .
Celiac plexus block is an extremely palliative treatment of chronic upper abdominal visceral pain, a successful block can be expected in over 80% of patients in expert hand