Brown, David L.

Background and Objectives. A pancreatic cancer patient developing transient paraplegia compatible with spinal cord ischemia, following alcohol celiac plexus neurolysis, is described. Methods. A 58-year-old man with metastatic pancreatic cancer underwent celiac (deep splanchnic) alcohol neurolysis for management of severe epigastric and midback pain. In spite of apparently adequate needle position, he developed transient paraplegia consistent with anterior spinal artery syndrome. Results. The clinical findings suggest ischemia of the anterior spinal cord with complete motor and sensory paralysis to a T8 spinal cord level resulting from an anterior spinal artery syndrome. Conclusions. The cause of the limited bilateral transient paralysis following celiac plexus block in this patient may involve ischemia of the spinal cord associated with reversible arterial spasm following the injection of ethanol solution.

Background and Objectives Neurolytic celiac plexus block is often performed for analgesia from pancreatic cancer, but it is not known if the cancer alters the anatomy relevant to the successful performance of retrocrural celiac plexus block. Methods Abdominal computed tomographic scans were used to simulate retrocrural celiac plexus block in patients with and without pancreatic cancer. Results Simulated right-sided needle placement in the retrocrural space was more likely to fail in patients with pancreatic cancer than in patients without cancer. Such predicted failure often occurred when the cross-sectional area of the right retrocrural space was less than 1.0 cm2. Conclusions The predicted success of simulated retrocrural celiac plexus block differed between patients with and without pancreatic cancer. These findings have implications for the performance of celiac plexus block.