Coeliac Plexus Block — FRCA Final MCQ

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ModeratePain MedicineCoeliac Plexus BlockFRCA Final

A 48-year-old man with chronic pancreatitis has severe abdominal pain despite multimodal analgesia. A conventional bilateral posterior percutaneous coeliac plexus block is planned using fluoroscopic guidance. In this technique, the needles are directed towards the lateral aspect of which vertebral body as the principal bony landmark before final needle position is confirmed using contrast?

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Correct answer: C — L1

The correct answer is C: the L1 vertebral body. In the conventional posterior fluoroscopic technique, L1 is used as the principal bony landmark for bilateral needle advancement; final placement and injectate spread must then be confirmed with imaging and contrast. The coeliac plexus surrounds the origin of the coeliac trunk on the anterior and anterolateral aorta, but its precise vertebral relationship varies. T12 is therefore a plausible distractor because the coeliac axis and ganglia may lie at T12 or the T12–L1 junction; it is not the standard bony target specified for this technique. T10 is too cephalad, while L2 and L3 are too caudal. The original generic wording required repair because CT-guided, posterior and endoscopic approaches should not be conflated.

Reference: Wu DJY et al. Coeliac plexus block in the management of chronic abdominal pain due to severe diabetic gastroparesis. BMJ Case Reports. 2009. https://pubmed.ncbi.nlm.nih.gov/22121392/