• Kazuhiko Hirata, Kazuo Higa, Shinjiro Shono, Kazunori Hirota, and Tetsuya Shinokuma.
• Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan. hiratakz@fukuoka-u.ac.jp
• Reg Anesth Pain Med. 2003 Jan 1;28(1):68-9.

Background And ObjectiveIodinated contrast agents are usually used to verify correct spread of injectate during splanchnic neurolysis. We performed a splanchnic neurolysis by using carbon dioxide as the contrast agent in a patient who was allergic to iodinated contrast agents.Case ReportA 49-year-old man had severe upper abdominal and back pain due to chronic pancreatitis. Because slow-release morphine 360 mg a day and epidural fentanyl 500 microg a day did not relieve the pain, a splanchnic neurolysis was performed by the posterior approach. The needle tip was placed into the retrocrural space under fluoroscopic guidance. Fifteen milliliters of carbon dioxide was injected as the contrast agent. It gave a less clear image than that obtained by iodinated contrast agents; however, the correct spread of the gas was easily visible under continuous fluoroscopy. Six percent aqueous phenol 8 mL was injected after confirming relief of the pain with a local anesthetic. The dose of slow-release morphine was gradually decreased after the procedure. His abdominal and back pain was controlled with slow-release morphine 120 mg a day.ConclusionCarbon dioxide was useful as the contrast agent to perform splanchnic neurolysis.

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