To the Editor:--The case report by Kaplan et al. [1]in which fluoroscopy was used to verify needle placement when attempting neurolytic celiac plexus block (NCPB) and that resulted in paraplegia and death raised a question.

The incidence of a catastrophic sequela after NCPB has been stated to be 1.0–2.0%. [2–4]Cases of paraplegia have been reported after NCPB with the use of fluoroscopy to verify needle placement [5,6]and without the use of any type of roentgenography. [2,7]A Medline search revealed no complications from NCPB when needle placement was verified using computed tomography (CT).

During NCPB, CT interpreted by a radiologist, unlike fluoroscopy, which is usually interpreted by the anesthesiologist performing the block, certifies whether the needle's bevel is in the wall of a major blood vessel, passes through a kidney, or lies inside the pleura or in the epidural or subarachnoid space. [3,6].

If the readers of this letter know of the occurrence of a catastrophic sequela from NCPB using CT, it would be helpful in evaluating whether any roentgenographic technique could eliminate a catastrophe from NCPB.

Daniel C. Moore, M.D., Department of Anesthesiology (Emeritus), Virginia Mason Medical Center, Seattle, Washington 98111–0900.

Kaplan R, Schiff-Keren B, Alt E: Aortic dissection as a complication of celiac plexus block. ANESTHESIOLOGY 1995; 83:632-5.
Brown DL, Moore DC: The use of neurolytic celiac plexus block for pancreatic cancer: Anatomy and technique. J Pain Symptom Manage 1988; 3:206-9.
Lieberman RP, Waldman SD: Celiac plexus neurolysis with the modified transaortic approach. Radiology 1990; 175:274-6.
Eisenberg E, Carr DB, Chambers TC: Neurolytic celiac plexus block for treatment of cancer pain: A meta-analysis. Anesth Analg 1995; 80:290-5.
Cherry DA, Lamberty J: Paraplegia following coeliac plexus block. Anaesth Intensive Care 1984; 12:59-61.
Woodham MJ, Hanna MH: Paraplegia after coeliac plexus block. Anaesthesia 1989; 44:487-9.
Galizia EJ, Lahiri SK: Paraplegia following coeliac plexus block with phenol: A case report. Br J Anaesth 1974; 46:539-40.