Computed Tomography-guided Celiac Plexus Block for Treatment of Intractable Upper Abdominal Pain

The purpose of this study was to evaluate the therapeutic result of CT; guided celiac plexus block (CPB) for managing intractable upper abdominal pain due to pancreatic carcinoma or chronic pancreatitis. CT-guided CPB was performed in 6 patients with severe epigastric pain evaluated clinically to be of celiac ganglion origin. Evaluation of the alcohol solution spread was based on the presence of the contrast medium around the celiac area. A subjective evaluation of the degree of pain relief was graded from 1+ (no change) to 4+ (complete relief). An objective evaluation was also obtained by comparing average daily analgesic usage before and after the procedure. Ethanol injection was performed successfully in 4 patients with pancreatic carcinoma and in 2 patients with chronic pancreatitis. One of the 6 patients had considerable (3+) relief of pain immediately, while 5 had complete (4+), immediate pain relief. The pain relief effectiveness gradually decreased in 3 patients, while in the other 3 the pain relief was more longlasting. Narcotic analgesics and/or general anesthetics consumption was significantly lower after the CPB procedure in all patients. No neurologic complications were observed in these patients. CT-guided CPB is a safe and effective method of pain control in patients with severe upper abdominal pain caused by pancreatic carcinoma or chronic pancreatitis. It may prevent deterioration in quality of life by the long-lasting analgesic effect, reducing drug administration and drug-related adverse effects.