To the Editor:--Kaplan et al. reported a case of aortic dissection as a complication of celiac plexus block. [1]In my opinion, this complication may have been avoided if the block had been performed using fluoroscopic control with contrast, particularly when the normal vascular area was distorted by invasive tumor.

The patient was reported to be allergic to contrast media. However, severe reactions to newer generations of contrast media are rare, even in patients with previous adverse reactions. It is important to obtain a detailed allergic history, e.g., which contrast agent was used, nonionic versus ionic, high-osmolality versus low-osmolality, procedure, route of administration, the nature of the reaction, and the treatment for the reaction. Low-osmolality, nonionic agents usually are used in patients at risk because they produce fewer side effects. Prevalence of severe reactions from using these agents in this group of patients is less than 1 in 3,000. [2]Steroid and antihistamine premedications have been shown to decrease the frequency and severity of adverse reactions to contrast media. [3].

The authors commented that the patient experienced generalized body pain during injection of alcohol and attributed this painful response to intraarterial injection. Intravascular and possible intramedial injections can be identified easily if contrast medium is used with the neurolytic agent. I also suspect intravascular injection of alcohol would produce more of a central nervous system depression. Finally, the effective use of oral opioids and the availability of epidural/spinal infusion techniques in treating malignant pain may place neurolytic celiac block out of favor.

YiYan Hong, MD, Assistant Professor, Consultant, Pain Management Center/Department of Anesthesiology, Temple University, Health Science Center, 3401 North Broad Street, Philadelphia, Pennsylvania 19140

Kaplan R, Schiff-Keren B, Alt E: Aortic dissection as a complication of celiac plexus block. ANESTHESIOLOGY 1995; 83:632-4.
McClennan B: Adverse reactions to iodinated contrast media, recognition and response. Investi Radiol 1994; 29(suppl 1):S46-50.
Weiss ME, Hirshman CA: Anaphylactic reactions and anesthesia, Principles and Practice of Anesthesiology. Edited by Rogers MC, Tinker JH, Covino BG, Longnecker DE. St. Louis, Mosby Year Book, 1993, p 2472.