SK Shin, et al / Ejaculatory Failure after Celiac Plexus Block 275 gastric pain and severe postprandial pain of 7/10 on a vis- ual analogue scale (VAS) score of 0 to 10, which was domi- nant on the left side. The pain itself was well controlled at a VAS of 2/10 with opioid analgesics, but the patient experienced severe constipation and sedation and re- quested a nerve block in an attempt to reduce his pain medication. He was taking 40 mg of oxycodone four times a day and 8 mg of hydromorphone daily. The patient's most recent abdomino-pelvic CT showed no evidence of tumor recurrence, and atrophic change of the pancreas. Other- wise, there were no anatomical distortions within the pa- tient's abdominal cavity. After obtaining a written consent form from the patient, we performed an elective left sided unilateral celiac plexus block under fluoroscopy guidance with the patient in the right lateral decubitus position. The patient's pain was clearly dominant on the left side, and because the source of his pain was a benign disease, a unilateral block was chosen in an attempt to reduce any possible complications. A skin wheal was raised with 1% lidocaine at a point 7 cm lateral to the L1 spinous process which corresponded to the inferior edge of the 12th rib, and a 15-cm 22-gauge needle was introduced at a 45 degree angle until it made bony contact with the L1 vertebral body. The needle's angle was adjusted as it was advanced by sliding off the anterolateral side of the vertebral body until it reached the anterior margin of the L1 vertebral body in the lateral view. A 10 ml plastic syringe filled with saline was then attached to the needle hub, and the needle was advanced slowly until loss of resistance was felt and pulsations of the aortic wall could be identified along the shaft of the needle. After the needle was aspirated and found to be negative for blood, a diagnostic block was done with 5 ml of 2% lidocaine mixed in 5 ml of iohexol (OmnipaqueTM, GE Healthcare Ireland, Carrigtohill, County Cork, Ireland) and adequate spread of dye was confirmed in the anterior-posterior and lateral view radiographs (Fig. 1). The patient was examined for any sensory or motor deficits for 20 minutes, and fluo- roscopic evaluation was done to check for any delayed dye spread in unwanted regions such as across the midline of the vertebral bodies in the anterior view and posterior spread or along the psoas muscles in the lateral view. We checked for any numbness or dysesthesia in the T10-L2 dermatomes and weakness in quadriceps function as well as the patient's ability to wiggle his toes. When the pa- tient's abdominal pain had resolved and no other side ef- fects were observed, NCPB was done with 8 ml of 99% an- hydrous alcohol (Dehydrated Alcohol Injection, Daihan, Ansan, Gyeonggido, Korea). The patient was followed up for 1 week until discharge from the hospital, and showed no motor or sensory deficits, hypotension or diarrhea. His pain medication was reduced to half of the pre-procedure dose, and the patient's pain was well controlled at a VAS score of 2/10. When the patient came to our out-patient clinic 1 month after discharge, his pain was still well con- trolled with reduced oral analgesics, but he reported that he had been unable to ejaculate since the procedure. He described his symptom as "a faucet turned off tight", and that he could not ejaculate during climax, which was a symptom that he had not experienced before the NCPB. We referred him to the department of urology and he is being followed-up under the impression of retrograde Fig. 1. (A) Anterior-posterior radiograph of dye spread. (B) Lateral radiograph of dye spread.