Evaluation of outcomes of ultrasound guided celiac plexus neurolysis using immediate post procedure computed tomography: An observational study.

BACKGROUND

An interventional procedure like celiac plexus neurolysis (CPN) has a significant role in relieving intractable pain in patients with locally advanced abdominal malignancies. Ultrasound (USG) guidance enables performance of bedside CPN by real-time visualization of the needle trajectory. The objective of the study was to perform percutaneous USG-guided CPN and to verify technical outcomes of the procedure using a post-procedure CT scan.

METHODS

Eleven eligible patients of advanced upper abdominal malignancies having a pain score of >3/10 on visual analog scale (VAS) were recruited to undergo CPN. A post-procedure CT scan was performed to evaluate technical outcomes of the procedure. Patients were evaluated for pain relief. They were followed up at the 1st, 4th, and 6th weeks after CPN.

RESULTS

Eleven patients underwent USG-guided CPN. The injected drug was visualized as an echogenic cloud in ultrasound in 7 out of 11 (64%) patients. In the remaining 4 patients, the echogenic cloud was not well formed. In the post-procedure CT scan, the spread of the drug was seen in all 11 patients. This spread was bilaterally symmetrical in 7 (64%) patients and asymmetrical or unilateral in 4 (36%) patients. All patients in the immediate post-procedure period and 91% of the patients during the 1st-, 4th-, and 6th-week follow up had improvement in their pain scores.

CONCLUSION

A post-procedure CT scan was useful in verifying the technical outcome of USG-guided CPN in patients with advanced upper abdominal malignancies.