Splanchnic nerve block is performed to relieve intractable upper abdominal pain caused by carcinoma of the pancreas, stomach, liver, or colon; and upper abdominal metastasis of tumors having more distant origins. We have performed splanchnic nerve blocks under control of X-ray fluoroscopy, for all cases of alcohol splanchnic nerve block at $L_1$ vertebra, to determine both the position of the needle tips and the spread of contrast media. During the period from December 1987 to August 1988, this method was used in 40 cases of malignancy at Severance Hospital and we clinically evaluated the location of the needle tip and the spread of contrast media. The results were as follows: 1) Our method was a retrocrural approach, the splanchnic nerve block, in all cases. 2) Most of the inserted needle points were located in the upper and anterolateral part of the $L_1$ vertebra on the antero posterior roentagenogram and in the upper quarter anteriorly on the lateral roentgenogram. 3) There was no specific relationship between the location of the needle and the spread of the contrast media. 4) The contrast media was spread around the needle and then upward along the anterior margin of the vertebral body in most of the cases. 5) Pain relief was obtained immediately in 37 cases (92.5%), but in 3 cases only after a second splanchnic nerve block.