Article Text

Download PDFPDF
Splanchnic Neurolysis Using Carbon Dioxide as the Contrast Agent
  1. Kazuhiko Hirata, M.D.,
  2. Kazuo Higa, M.D.,
  3. Shinjiro Shono, M.D.,
  4. Kazunori Hirota, M.D. and
  5. Tetsuya Shinokuma, M.D.
  1. From the Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka, Japan.
  1. Reprint requests: Kazuhiko Hirata, M.D., Department of Anesthesiology, Fukuoka University School of Medicine 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. E-mail: hiratakz{at}


Background and Objective Iodinated contrast agents are usually used to verify correct spread of injectate during splanchnic neurolysis. We performed a splanchnic neurolysis by using carbon dioxide as the contrast agent in a patient who was allergic to iodinated contrast agents.

Case Report A 49-year-old man had severe upper abdominal and back pain due to chronic pancreatitis. Because slow-release morphine 360 mg a day and epidural fentanyl 500 μg a day did not relieve the pain, a splanchnic neurolysis was performed by the posterior approach. The needle tip was placed into the retrocrural space under fluoroscopic guidance. Fifteen milliliters of carbon dioxide was injected as the contrast agent. It gave a less clear image than that obtained by iodinated contrast agents; however, the correct spread of the gas was easily visible under continuous fluoroscopy. Six percent aqueous phenol 8 mL was injected after confirming relief of the pain with a local anesthetic. The dose of slow-release morphine was gradually decreased after the procedure. His abdominal and back pain was controlled with slow-release morphine 120 mg a day.

Conclusion Carbon dioxide was useful as the contrast agent to perform splanchnic neurolysis. Reg Anesth Pain Med 2003;28:68-69.

  • Splanchnic neurolysis
  • Carbon dioxide
  • Contrast agent
  • Chronic pancreatitis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.