A case of visceral nerve block turned into a celiac plexus block due to osteophyte formation

Abstract

We report a case in which a splanchnic nerve block for osteophyte formation resulted in diaphragmatic puncture during the procedure and was converted to a celiac plexus block. A man in his 70s with severe opioid-resistant abdominal pain due to pancreatic tail cancer was scheduled for a splanchnic nerve block. Pre-block imaging revealed osteophyte formation in his spine. While performing the block, the needle tip traversed the osteophyte and reached the diaphragmatic crus, resulting in diaphragmatic contrast. With the safety of the needle position confirmed by CT-like imaging, we proceeded to advance the needle and performed the celiac plexus block. Unnoticed diaphragmatic puncture during neuroleptic drug injection may cause complications such as upper abdominal, lateral thoracic, and shoulder discomfort, along with diaphragmatic nerve palsy. Need to pay attention to contrast findings during the block.