An anatomical study in cadavers

Percutaneous coeliac plexus and lumbar sympathetic blocks were performed "blind " in cadavers to investigate the frequency of puncture of a major organ. In a series of 120 needle placements, the kidney was punctured on only one occasion and this would almost certainly have been prevented by the use of fhioroscopy. The proximity of the needles to the lumbar sympathetic chain support the efficacy of this technique. The frequency of puncture of a major organ, in particular the kidney, during coeliac plexus block has been reported recently to be greater than be-lieved previously (Moore, Bush and Bennett, 1981). Since the method of performing lumbar sympathe-tic blockade percutaneously is not dissimilar (Reid, Watt and Gray, 1970), similar possibilities exist. Needles were inserted "blind " to the regions of the coeliac plexus and lumbar sympathetic chain in 20 cadavers to determine what major structures were punctured, and to assess how precisely the needles had been placed in relation to the lumbar sympathetic chain. MATERIALS AND METHODS The technique of inserting the needles was based on that described by Reid, Watt and Gray (1970). Only cadavers which were about to be subjected to post-mortem were used, and no mutilating procedures were undertaken. With the cadaver in the lateral position, three 22-gauge, 15-cm needles were inserted approxi-mately 10 cm (4 in) from the midline at the approxi-mate levels of L I, L2 and L3. In thin cadavers the distance of insertion of the needles from the midline was less, approximately 7.5 cm, while in obese sub-jects the distance was greater (up to 12.5 cm). Each needle was advanced on to the vertebral body, gradually positioned more anteriorly until it slipped beyond the antero-lateral aspect of the vertebral body and then advanced to the "hilt " to allow the cadaver to be positioned supine. The cadaver was then rolled over and the performanc