Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Pain. 2013 Oct;26(4):396-400. doi: 10.3344/kjp.2013.26.4.396. Epub 2013 Oct 2.
Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.
传统的经胫骨外侧 CPB 通过“走下”椎骨技术，在尝试将注射物近端扩散到腹腔神经丛周围时，可能会损伤重要器官。因此，我们尝试了 CT 模拟透视引导下经椎间盘入路，以更安全的方式进行经胫骨外侧 CPB，使注射物更完全、更紧密地扩散到腹腔神经丛区域。一名 54 岁男性胰腺癌患者患有严重的上腹痛。模拟了传统的经胫骨外侧入路，但由于右侧肾脏和左侧主动脉的存在，导致针道受阻。通过 T11-12 椎间盘模拟经椎间盘入路后，我们预先确定了最佳的插入点（距中线 3.6 厘米）、插入角度（18 度）和推进平面以及适当的深度。通过经椎间盘入路，我们成功地在狭窄的角度下进行了经胫骨外侧 CPB，并且不需要双侧入路，因为我们能够通过单次入路实现双侧注射物的扩散。
