Atlas of Pain Medicine Procedures by Diwan Sudhir & Staats Peter

Author:Diwan, Sudhir & Staats, Peter
Language: eng
Format: epub
Publisher: McGraw-Hill Education
Published: 2014-10-21T16:00:00+00:00

Medications

• Omnipaque 240

• 1% lidocaine with epinephrine

• 0.25% or 0.5% bupivacaine

• Occasionally steroids are added for pancreatitis

• For neurolysis—10 to 20 cc 50% to 100% alcohol

Technique

Different techniques have been advocated in the performance of the celiac plexus block. All techniques should use some type of advanced imaging in performance of the block. Fluoroscopic guidance, CT guidance, and ultrasound guidance have demonstrated to be effective. Advocates of fluoroscopic guidance point to dynamic imaging and the rapidity with which the procedure can be performed. CT guidance can be done in the prone or supine position and can demonstrate aberrant anatomy and flow of contrast more carefully. Ultrasound guidance is now being performed from a transesophageal approach, usually by the gastroenterologist, and can be done at the time of an endoscopy. The superiority of one approach over another has not been demonstrated.

We will describe here the classic retrocrural approach via fluoroscopy in the prone position using 2 needles.

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