case_images: PMC11786681_01
case_images: Multiplanar views of the splanchnic block procedure at the T11 level. These images show an anterior-posterior view (a), lateral view (b), and lateral view after contrast (c) of the thoracic spine using fluoroscopy. The anatomical target site was identified using fluoroscopy by aligning the superior endplate of T11 and then tilting the C-arm intensifier to position the tip of the T11 transverse process at the anterolateral border of the T11 vertebral body. The C-arm was then tilted upwards to move the 12th rib out of the way. The target was identified over the left lower part of the T11 vertebral body (A). A local anesthetic was administered by creating a skin wheal and inserting a 25-gauge, 1.25-inch needle to reach the hub. A 22-gauge, 100 mm spinal needle was then carefully guided just below the 11th rib. The needle was carefully advanced with continuous contact with the vertebral body, and multiple anterior-posterior and lateral fluoroscopy images (B) were taken to ensure the needle remained close to the vertebral body. The needle tip was advanced until it was just in front of the front edge of the T11 body (B). After confirming no aspiration, 2 cc of Isovue contrast was injected under live fluoroscopy, which showed excellent spread in the area in front of the vertebral body (C).
case_images: gr1.jpg
case_images: PMC11786681_01_gr1.jpg
case_images: fig1
case_images: A diagnostic and therapeutic left splanchnic nerve block (Fig. 1) was performed, involving the injection of 14 mL of 0.25 % bupivacaine with 1 mL of dexamethasone (4 mg).
case_images: Multiplanar views of the splanchnic pulsed radiofrequency treatment procedure at the T11 level are presented. These images include an anterior-posterior view (a) and a lateral view (b), as detailed in Fig. 1.
case_images: gr2.jpg
case_images: PMC11786681_01_gr2.jpg
case_images: fig2
case_images: Given the encouraging results, the patient was scheduled for unilateral pulsed RF treatment of the left splanchnic nerves (Fig. 2) at the T11 vertebral body level to achieve longer-lasting pain control.