Coeliac Plexus Block Level — FRCA Primary MCQ

Correct answer: D — L1

The correct answer is D, L1. In the classical bilateral posterior fluoroscopic approach, the needles are directed to the anterolateral aspect of the L1 vertebral body, close to the abdominal aorta and the origins of the coeliac and superior mesenteric arteries. T12 is a plausible distractor because the coeliac trunk and coeliac ganglia commonly project at T12 or the T12-L1 junction, and their position varies between patients. It is therefore not accurate to describe every image-guided coeliac plexus block as occurring at one invariant anatomical level. However, once the question specifies the conventional posterior fluoroscopic landmark, L1 is the FRCA answer. T10 is more relevant to the thoracic splanchnic nerves, whereas L2 and L4 are too caudal for the coeliac plexus.

Reference: Royal College of Anaesthetists. Guide to the FRCA Examination—The Final, Fourth Edition, question 56 answer, 2020. https://www.rcoa.ac.uk/media/49226