Celiac plexus blockade (CPB) is a palliative procedure for intractable upper abdominal pain. Needle localization is achieved with bony landmarks, fluoroscopy, ultrasound, computed tomography (CT), and most recently, magnetic resonance imaging (MRI). Current literature suggests a volume of least 20 ml is necessary to achieve adequate blockade, with severe complications noted in some instances, including paraplegia. We report a successful low-volume neurolytic CPB under interventional MRI guidance.

MATERIALS/METHODS:

A consult for a CPB was completed for a 71-year-old morbidly obese female with terminal pancreatic cancer, ESRD,and CHF. The patient reported inconsolable, boring upper abdominal pain unresponsive to high dose narcotics and had not eaten for several days.

After informed consent and application of routine monitors, the patient was placed prone inside the scanner (0.5 Tesla GE Sigma SP). A surgical corridor and safe needle tract with distance to target point were established by axial and sagittal gradient echo imaging at L1. A MRI compatible 15cm, 22G needle was advanced via a left-sided transcrural approach with a target position posterolateral to the celiac artery origin in tissue presumed to be neural plexus. 5ml of 1% lidocaine was injected after negative aspiration to visualize proper spread at the target site. Next, a 10ml solution of 10% phenol was injected slowly without complication and the patient was transported back to the ward after a brief monitoring period.

RESULTS:

The patient reported 100% relief of all preoperative symptoms while maintaining hemodynamic stability. Upon return to the ward, the patient immediately requested a food tray and was discharged the following day requiring no analgesic medication.

CONCLUSION:

IMRI guidance offers improved visualization of vital soft tissue structures, making needle placement for CPB both safer and more precise. This technique minimizes injectate volume required for adequate blockade, decreasing the inherent risk of spread to surrounding tissues.