To the Editor:--The case report by Kaplan et al. 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.