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Alternative Method of Retrocrural Approach during Celiac Plexus Block Using a Bent Tip Needle

 Ji Won An  ;  Eun Kyeong Choi  ;  Chol Hee Park  ;  Jong Bum Choi  ;  Dong Kyun Ko  ;  Youn Woo Lee 
 KOREAN JOURNAL OF PAIN, Vol.28(2) : 109-115, 2015 
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Bent tip needle ; Celiac plexus block ; Fluoroscopy ; Retrocrural approach ; Visceral pain
BACKGROUND: This study sought to determine safe ranges of oblique angle, skin entry point and needle length by reviewing computed tomography (CT) scans and to evaluate the usefulness of a bent tip needle during celiac plexus block (CPB).
METHODS: CT scans of 60 CPB patients were reviewed. Image of the uppermost margin of L2 vertebral body was used to measure the minimal and maximal oblique angles and the distances from the midline to skin puncture point. The imaginary needle trajectory distance was calculated by three-dimensional measurement. When the procedure was performed by using a 10° bent tip needle under a 20° oblique X-ray fluoroscopic view, the distance (GF/G'F) from the midline to the actual puncture site was measured.
RESULTS: The imaginary safe oblique angle range was 26.4-34.2° and 27.7-36.0° on the right and left, respectively. The distance from the midline to skin puncture point was 6.1-7.6 cm on the right and 6.3-7.6 cm on the left. The needle trajectory distance at minimal angle was 9.6-11.6 cm on the right and 9.5-11.5 cm on the left. The distance of GF/G'F was 5.1-6.5 cm and 5.0-6.4 cm on the right and left, respectively. All imaginary parameters were correlated with BMI except for GF/G'F. All complications were mild and transient.
CONCLUSIONS: We identified safe values of angles and distances using a straight needle. Furthermore, using a bent tip needle under a 20° oblique fluoroscopic view, we could safely perform CPB with smaller parameter values.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Ko, Dong Kyun(고동균)
Park, Chol Hee(박철희)
An, Ji Won(안지원)
Lee, Youn Woo(이윤우)
Choi, Eun Kyeong(최은경)
Choi, Jong Bum(최종범)
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