A fluoroscopically guided anterior approach to celiac plexus block was developed that can be performed on the supine patient during a percutaneous biliary procedure. Unlike posterior blocks, anterior blocks can be performed at any time during the procedure and thus can be reserved for the few patients whose pain does not respond to intravenously administered narcotics. Anterior blocks were performed 18 times in 14 patients; satisfactory visceral anesthesia was achieved in ten of the 18 procedures.

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A prospective, double-blind evaluation using 3 ml of 10% cocaine, 0.5% phenylephrine with 5% Xylocaine, and 0.05% oxymetazoline with 5% Xylocaine was conducted to compare the anesthetic, decongestant, and systemic effects of each of the drugs. Degree of anesthesia was measured by placing a probe on the nasal mucosa in the area of Kisselbach's plexus and passing an electric current until a sensation could just be felt. Decongestant properties were assessed using anterior rhinomanometry. Systemic effects were determined by continuous blood pressure and pulse recordings and by recording subject comments. Cocaine showed better anesthesia, slower onset of vasoconstriction, significant blood pressure elevation, and multiple subjective side effects. Phenylephrine mixtures showed almost no unpleasant side effects, more rapid vasoconstriction than cocaine, and statistically significant anesthesia. Oxymetazoline mixture did not offer any advantages in anesthesia or vasoconstriction and produced the most unpleasant side effects. Cocaine appears to be the drug of choice for long surgical procedures in patients with normal cardiorespitatory systems. Phenylephrine with Xylocaine may be used as the drug of choice for shorter office procedures for those patients with cocaine sensitivity.