• S C Krämer, R Meier, and H Seifarth.
• Klinik für diagnostische und interventionelle Radiologie und Nuklearmedizin, Klinikum Esslingen gGmbH, Hirschlandstr. 97, 73730, Esslingen, Deutschland, S.Kraemer@klinikum-esslingen.de.
• Radiologe. 2015 Jun 1; 55 (6): 458-61.

BackgroundPain originating from the organs of the upper abdomen, especially in patients suffering from inoperable carcinoma of the pancreas or advanced inflammatory conditions, is difficult to treat in a significant number of patients.Standard Radiological ProceduresComputed tomography (CT) guided neurolysis is the most commonly used technique for neurolysis of the celiac plexus. Ethanol is used to destroy the nociceptive fibers passing through the plexus and provides an effective means of diminishing pain arising from the upper abdomen.MethodsUsing either an anterior or posterior approach, a 22 G Chiba needle is advanced to the antecrural space and neurolysis is achieved by injecting a volume of 20-50 ml of ethanol together with a local anesthetic and contrast medium.PerformanceIn up to 80% of patients suffering from tumors of the upper abdomen, CT-guided celiac plexus neurolysis diminishes pain or allows a reduction of analgesic medication; however, in some patients the effect may only be temporary necessitating a second intervention. In inflammatory conditions, celiac neurolysis is often less effective in reducing abdominal pain.Practical RecommendationsThe CT-guided procedure for neurolysis of the celiac plexus is safe and effective in diminishing pain especially in patients suffering from tumors of the upper abdomen. The procedure can be repeated if the effect is only temporary.

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