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CT-guided nerve block: a review of the features of CT fluoroscopic guidance for nerve blocks

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Abstract

Nerve blocks are an attractive interventional therapy in pain medicine. Several image guidance methods are available to secure the safety, accuracy, and selectivity of the nerve block. Computed tomography (CT) guidance provides a clear view of the vital viscera and vessels that should be avoided by the needle, and accurate placement of the needle tip before neuro-destructive procedures. A recent advance in CT technology is multi-slice CT fluoroscopy, which allows for rapid and easy correction of needle tip placement during insertion. To reduce the radiation dose for both patients and staff, the lowest radiation setting, intermittent quick-check fluoroscopy, and shortening of the planning scan should be used. Preliminary CT scanning with excellent spatial resolution may facilitate the application of CT fluoroscopic guidance to various types of nerve blocks. Here we review celiac plexus and splanchnic nerve blocks, trigeminal nerve block, neurolytic sympathectomy, and spinal intervention performed under CT guidance. Additional large-scale studies are needed to optimize the use of image guidance, especially CT fluoroscopy guidance, for nerve blocks.

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References

  1. Curatolo M, Bogduk N. Diagnostic and therapeutic nerve blocks. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. Bonica’s management of pain. 4th ed. Philadelphia: Lippincott; 2010. p. 1401–23.

    Google Scholar 

  2. Breivik H, Cousins MJ. Sympathetic neural blockade of upper and lower extremity. In: Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO, editors. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Lippincott; 2009. p. 848–85.

    Google Scholar 

  3. Ryttov N, Boe S, Nielsen H, Jacobsen J. Necrosis of ureter as a complication to chemical lumbar sympathectomy. Report of a case. Acta Chir Scand. 1981;147:79–80.

    CAS  PubMed  Google Scholar 

  4. Koizuka S, Saito S, Obata H, Tobe M, Koyama Y, Takahashi A. Anatomic analysis of computed tomography images obtained during fluoroscopic computed tomography-guided percutaneous lumbar sympathectomy. J Anesth. 2008;22:373–7.

    Article  PubMed  Google Scholar 

  5. Koizuka S, Saito S, Masuoka S, Nakajima K, Koyama Y. Location of major vessels in prone-positioned patients undergoing percutaneous lumbar sympathectomy. Neuroradiology. 2012;54:1127–31.

    Article  PubMed  Google Scholar 

  6. Curatolo M, Eichenberger U. Ultrasound-guided blocks for treatment of chronic pain. Tech Reg Anesth Pain Manag. 2007;11:95–102.

    Article  Google Scholar 

  7. Alfidi RJ, Haaga JR, Meaney TF, MacIntyre WJ, Gonzalez L, Tarar R, Zelch MG, Boller M, Cook SA, Jelden G. Computed tomography of the thorax and abdomen: a preliminary report. Radiology. 1975;117:257–64.

    CAS  PubMed  Google Scholar 

  8. Haaga JR, Reich NE, Havrilla TR, Alfridi RJ. Interventional CT scanning. Radiol Clin N Am. 1977;15:449–56.

    CAS  PubMed  Google Scholar 

  9. Kambadakone A, Thabet A, Gervais DA, Mueller PR, Arellano RS. CT-guided celiac plexus neurolysis: a review of anatomy, indications, technique, and tips for successful treatment. RadioGraphics. 2011;31:1599–621.

    Article  PubMed  Google Scholar 

  10. Buy JN, Moss AA, Singler RC. CT guided celiac plexus and splanchnic nerve neurolysis. J Comput Assist Tomogr. 1982;6(2):315–9.

    Article  CAS  PubMed  Google Scholar 

  11. Haaga JR, Kori SH, Eastwood DW, Borkowski GP. Improved technique for CT-guided celiac ganglia block. AJR Am J Roentgenol. 1984;142(6):1201–4.

    Article  CAS  PubMed  Google Scholar 

  12. Lee MJ, Mueller PR, van Sonnenberg E, Dawson SL, D’Agostino H, Saini S, Cats AM. CT-guided celiac ganglion block with alcohol. AJR Am J Roentgenol. 1993;161(3):633–6.

    Article  CAS  PubMed  Google Scholar 

  13. Ina H, Kitoh T, Kobayashi M, Imai S, Ofusa Y, Goto H. New technique for the neurolytic celiac plexus block: the transintervertebral disc approach. Anesthesiology. 1996;85(1):212–7.

    Article  CAS  PubMed  Google Scholar 

  14. Redman DRO, Robinson PN, Al-Kutoubi MA. Computed tomography guided lumbar sympathectomy. Anaesthesia. 1986;41:39–41.

    Article  CAS  PubMed  Google Scholar 

  15. Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, Judy PF. CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure. Radiology. 1999;212:673–81.

    Article  CAS  PubMed  Google Scholar 

  16. Katada K, Anno H, Takeshita G, Ogura Y, Koga S, Ida Y, Nonomura K, Kanno T, Ohashi A, Sata S, Shibata Y. Development of real-time CT fluoroscopy (in Japanese with English abstract). Nippon Igaku Hoshasenn Gakkai Zasshi (J Jpn Radiol Soc). 1994;54:1172–4.

    CAS  Google Scholar 

  17. Katada K, Kato R, Anno H, Ogura Y, Koga S, Ida Y, Sato M, Nonomura K. Guidance with real-time CT fluoroscopy: early clinical experience. Radiology. 1996;200(3):851–6.

    CAS  PubMed  Google Scholar 

  18. Sarti M, Brehmer WP, Gay SB. Low-dose techniques in CT-guided interventions. RadioGraphics. 2012;32:1109–19.

    Article  PubMed  Google Scholar 

  19. Koizuka S, Saito S, Sekimoto K, Tobe M, Koyama Y, Obata H. Percutaneous radio-frequency thermocoagulation of the Gasserian ganglion guided by high speed real-time CT fluoroscopy. Neuroradiology. 2009;51(9):563–6.

    Article  PubMed  Google Scholar 

  20. Koizuka S, Saito S, Tobe M, Sekimoto K, Obata H, Koyama Y. Percutaneous radio-frequency mandibular nerve rhizotomy guided by high-speed real-time CT fluoroscopy. Anesth Analg. 2010;111:763–7.

    Article  PubMed  Google Scholar 

  21. Kuroda M, Koizuka S, Saito S, Sato E, Takizawa D, Goto F. Computed tomography fluoroscopy-guided lumbar sympathectomy for a patient with peripheral vascular disease and lumbar spine compression fracture. J Anesth. 2005;19:268–9.

    Article  PubMed  Google Scholar 

  22. Wang PJ, Shang MY, Qian Z, Shao CW, Wang JH, Zhao XH. CT-guided percutaneous neurolytic celiac plexus block technique. Abdom Imaging. 2006;31:710–8.

    Article  CAS  PubMed  Google Scholar 

  23. Koizuka S, Saito S, Kubo K, Tomioka A, Takazawa T, Sakurazawa S, Goto F. Percutaneous radio-frequency mandibular nerve rhizotomy guided by CT fluoroscopy. AJNR Am J Neuroradiol. 2006;27(8):1647–8.

    CAS  PubMed  Google Scholar 

  24. Prosch H, Stadler A, Schilling M, Bürklin S, Eisenhuber E, Schober E, Mostbeck G. CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: accuracy, complications and radiation dose. Eur J Radiol. 2012;81(5):1029–33.

    Article  PubMed  Google Scholar 

  25. Paulson EK, Sheafor DH, Enterline DS, McAdams HP, Yoshizumi TT. CT fluoroscopy-guided interventional procedures: techniques and radiation dose to radiologists. Radiology. 2001;220:161–7.

    Article  CAS  PubMed  Google Scholar 

  26. Hoang JK, Yoshizumi TT, Toncheva G, Gray L, Gafton AR, Huh BK, Eastwood JD, Lascola CD, Hurwits LM. Radiation dose exposure for lumbar spine epidural steroid injections: a comparison of conventional fluoroscopy data and CT fluoroscopy techniques. AJR Am J Roentgenol. 2011;197:778–82.

    Article  PubMed  Google Scholar 

  27. Montero Matamala A, Vidal Lopez F, Aguilar Sanchez JL, Donoso Bach L. Percutaneous anterior approach to the coeliac plexus using ultrasound. Br JAnaesth. 1989;62(6):637–40.

    Article  CAS  Google Scholar 

  28. Fujita Y. CT-guided neurolytic splanchnic nerve block with alcohol. Pain. 1993;55(3):363–6.

    Article  CAS  PubMed  Google Scholar 

  29. Iki K, Fujita Y, Inada H, Satoh M, Tsunoda T. Celiac plexus block: evaluation of injectate spread by three-dimensional computed tomography. Abdom Imaging. 2003;28(4):571–3.

    Article  CAS  PubMed  Google Scholar 

  30. Levy MJ, Chari ST, Wiersema MJ. Endoscopic ultrasound-guided celiac neurolysis. Gastrointest Endosc Clin N Am. 2012;22(2):231–47.

    Article  PubMed  Google Scholar 

  31. Suresh S, Jagannathan N. Somatic blockade of the head and neck. In: Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO, editors. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Lippincott; 2009. p. 405–25.

    Google Scholar 

  32. Hickey AH, Scrivani S, Bajwa AZ. Cranial neuralgias. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. Bonica’s management of pain. 4th ed. Philadelphia: Lippincott; 2010. p. 953–72.

    Google Scholar 

  33. Okuda Y, Okuda K, Shinohara M, Kitajima T. Use of computed tomography for maxillary nerve block in the treatment of trigeminal neuralgia. Reg Anesth Pain Med. 2000;25(4):417–9.

    CAS  PubMed  Google Scholar 

  34. Okuda Y, Takanishi T, Shinohara M, Nagano M, Kitajima T. Use of computed tomography for mandibular nerve block in the treatment of trigeminal neuralgia. Reg Anesth Pain Med. 2001;26(4):382.

    Article  CAS  PubMed  Google Scholar 

  35. Sekimoto K, Koizuka S, Saito S, Goto F. Thermogangliolysis of the gasserian ganglion under computed tomography fluoroscopy. J Anesth. 2005;19:177–9.

    Article  PubMed  Google Scholar 

  36. Krol G, Arbit E. Percutaneous electrocoagulation of the trigeminal nerve using CT guidance. J Neurosurg. 1988;68:972–3.

    Article  CAS  PubMed  Google Scholar 

  37. Gusmao S, Oliveira M, Tazinaffo U, Honey CR. Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy. J Neurosurg. 2003;99:785–6.

    Article  PubMed  Google Scholar 

  38. Heindel W, Ernst S, Manshausen G, Gawenda M, Siemens P, Krahe T, Walter M, Lackner K. CT-guided lumbar sympathectomy: results and analysis of factors influencing the outcome. Cardiovasc Interv Radiol. 1998;21:319–23.

    Article  CAS  Google Scholar 

  39. Tay VKM, Fitridge R, Tie MLH. Computed tomography fluoroscopy-guided chemical lumbar sympathectomy: simple, safe and effective. Australas Radiol. 2002;46:163–6.

    Article  PubMed  Google Scholar 

  40. Rathmell JP, Pino CA, Ahmed S. Spinal pain and the role of neural blockade. In: Cousins MJ, Carr DB, Horlocker TT, Bridenbaugh PO, editors. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. 4th ed. Philadelphia: Lippincott; 2009. p. 1063–110.

    Google Scholar 

  41. Silbergleit R, Mehta BA, Sanders WP, Talati SJ. Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics. 2001;21:927–42.

    Article  CAS  PubMed  Google Scholar 

  42. Gangi A, Dietemann JL, Mortazavi R, Pfleger D, Kauff C, Roy C. CT-guided interventional procedures for pain management in the lumbosacral spine. RadioGraphics. 1998;18:621–33.

    Article  CAS  PubMed  Google Scholar 

  43. Wagner AL. Selective lumbar nerve root blocks with CT fluoroscopic guidance: technique, results, procedure time, and radiation dose. AJNR Am J Neuroradiol. 2004;25(9):1592–4.

    PubMed  Google Scholar 

  44. Wagner AL. CT fluoroscopy-guided epidural injections: technique and results. AJNR Am J Neuroradiol. 2004;25(10):1821–3.

    PubMed  Google Scholar 

  45. Wagner AL. CT fluoroscopic-guided cervical nerve root blocks. AJNR Am J Neuroradiol. 2005;26(1):43–4.

    PubMed  Google Scholar 

  46. Eckel TS, Bartynski WS. Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol. 2009;12:11–2.

    Article  PubMed  Google Scholar 

  47. Huegli RW, Schaeren S, Jacob AL, Martin JB, Wetzel SG. Percutaneous cervical vertebroplasty in a multifunctional image-guided therapy suite: hybrid lateral approach to C1 and C4 under CT and fluoroscopic guidance. Cardiovasc Interv Radiol. 2005;28:649–52.

    Article  CAS  Google Scholar 

  48. Wang Z, Zhen Y, Wu C, Li H, Yang Y, Shen Z, Zhao H, Yao Y. CT fluoroscopy-guided percutaneous osteoplasty for the treatment of osteolytic lung cancer bone metastases to the spine and pelvis. J Vasc Interv Radiol. 2012;23:1135–42.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan

    Shiro Koizuka, Kunie Nakajima & Rie Mieda

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  1. Shiro Koizuka
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  2. Kunie Nakajima
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  3. Rie Mieda
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Correspondence to Shiro Koizuka.

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Koizuka, S., Nakajima, K. & Mieda, R. CT-guided nerve block: a review of the features of CT fluoroscopic guidance for nerve blocks. J Anesth 28, 94–101 (2014). https://doi.org/10.1007/s00540-013-1675-8

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  • DOI: https://doi.org/10.1007/s00540-013-1675-8

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