1. 2026;29;E71-E78Computed Tomography-Guided Celiac Plexus Block and Neurolysis: Technical Outcomes and Complications
   Retrospective Study
   Mary Daniels, MD, Edgardo Duran, BS, Vincent Pan, BS, Peter Rentzepis, BS, Thomas An, MD, Ashraf Thabet, MD, and David Hao, MD.

BACKGROUND: Celiac plexus block (CPB) and celiac plexus neurolysis (CPN) are interventions used to treat chronic abdominal pain, particularly in cancer patients with pancreatic malignancy and patients who have chronic pancreatitis. Both CPB and CPN have been shown to significantly improve pain in patients with abdominal cancers while decreasing opioid consumption and side effects. Existing data on the technical variations and complications associated with both CPB and CPN are limited. 

OBJECTIVES: We sought to examine the technical factors, patient demographic data, and intra- and post-operative complications and side effects of CBP and CPN.  

STUDY DESIGN: We conducted a retrospective analysis of all patients at our institution who underwent CPB and/or CPN between September 2017 and February 2023. The study primarily included a chart review of patient data followed by statistical analysis. 

METHODS: Computed tomography-guided imaging was used for all patients’ CPB and/or CPN procedures, which included injections of either lidocaine or ethanol, respectively. Data were collected on patient demographics and baseline disease status, procedural indications, procedural technique, and intra- and post-procedural complications. Patients were stratified based on malignant and nonmalignant pain indications. 

RESULTS: Of the 141 patients included in the study, 70.2% of were found to have undergone treatment for malignancy-related pain. When assessing needle position, there were no significant differences in technical data between groups. Rates of side effects, including hypotension, diarrhea, and localized pain, were overall low and similar to those reported in meta-analyses. There was a subjective improvement in pain in 67.4% of all patients. 

LIMITATIONS: This study is limited by its retrospective observational nature and the inability to perform standardized pain scoring pre- and post-procedurally. Data on opioid use and consumption was inferred from prescribing data, which might not have accurately reflected real-world use. Despite these issues, this study provides insight into key patient data around CPB and/or CPN. 

CONCLUSIONS: This study bridges a gap in the literature to address both technical variables and procedural complications of the CPB for patients with malignant and nonmalignant pain. 

KEY WORDS: Celiac plexus block, celiac plexus neurolysis, chronic abdominal pain, pancreatic cancer pain, visceral pain, sympathetic blockade, alcohol neurolysis, CT-guided injection, cancer pain management, chronic pancreatitis pain, quality of life, regional anesthesia