CT guided neurolytic splanchnic nerve block with alcohol. Pain induced by electric stimulation

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Over three-year period, neurolytic visceral sympathectomy was performed bilaterally with 15 mL alcohol solution through each needle under CT guidance to relieve upper abdominal or back pain in 27 cancer patients. Using the CT monitor, our intention was to achieve splanchnic nerve neurolysis rather than celiac plexus neurolysis. After determining the trajectory for needle placement on the CT image at the L1 level, the needles were inserted bilaterally with a simple guide apparatus. The needle tips were successfully positioned in the retrocrural space in 48 (83%) among 54 insertions. Pain was substantially relieved in 20 out of 21 patients receiving bilateral splanchnic nerve neurolysis. Tissue pressure was significantly higher after alcohol injection when the needle tips were located in the retrocrural space than when they were located in the anterocrural space. CT images after alcohol injection revealed antero-and posterocrural spread in 11 of the 21 patients who received bilateral splanchnic nerve neurolysis. It was speculated that the alcohol spread through the aortic hiatus or gaps of the diaphragmatic crura. No neurologic complications were encountered. It is concluded that CT guided alcohol splanchnic neurolysis is an effective treatment for upper abdominal cancer pain, and that 15 mL of alcohol through each needle is enough for splanchnic neurolysis.