Celiac Plexus Block

Submitted by Rainier Guiang, M.D.

The celiac plexus is best approached from an oblique view by placing your needle onto the antero-lateral aspect of the L1 vertebral body As shown below.

Once there, walk the needle anterior to the vertebral body in the lateral view as shown below. You may feel a slight loss of resistance as your needle penetrates the diaphragm.

Needles should be placed bilaterally. Some advocate the use of a blunt needle through an introducer on the left in order to avoid the descending aorta. Slow step wise advancements should be performed while feeling for aortic pulsations.

Injection of local anesthetic +/- steroid should be performed. Ideally, you want to see your dye spread anterior to the vertebral body. Posterior spread may indicate a retrocrural spread. Injection of neurolytic agents posterior to the diaphragm may cause destruction of large vertebral nerve roots.

An example of bilateral spread of dye.