Abstract Background: Management of hepatocellular carcinoma related abdominal pain is a complex and challenging issue as most HCC develop on top of liver cirrhosis and the deficient hepatic function obstacle the high-dose narcotic analgesics. Imaging-guided Celiac plexus neurolysis for refractory pain management has been used for almost 100 years in patients with advanced abdominal malignancy and effectively control pain without the noted side effects typical of opioids, however CT guided celiac block is the most accurate method for celiac block guidance the lack of real time visualization, radiation exposure & time consuming call the need for real time CT fluoroscopy guidance. Aim of Study: To assess the efficacy of CT fluoroscopy in celiac plexus neurolysis in hepatocellular carcinoma related abdominal pain. Patient and Methods: This study was carried out on 30 adult patients suffering from abdominal pain due to infiltrative or metastatic HCC and pain not controlled by WHO analgesic step ladder. Celiac Plexus Neurolysis (CPN) is achieved with intravenous conscious sedation, prognostic block accomplished by using injecting a near by anesthetic accompanied with the aid of alcohol for celiac plexus block, after 10 minutes, if the injection correctly relieved pain; maximum filling of the retro-pancreatic area with ethanol is a sign of enough neurolysis. Results: Marked decrease of pain severity in all patients was noted as a sharp fall of the Numerical Rating Scale (NRS) score on the 1 st day post CPN with relatively stationary course for 3 months in the patient survived their primary disease. Conclusion: Celiac Plexus Neurolysis (CPN) provides an effective technique in decreasing pain severity in HCC patients, and so decreases the analgesic requirement, their side effects and may increase patients' survival, CT fluoroscopy guided CPN is an easy and safe procedure that provides high success rates, markedly decreased patient radiation dose and total procedure time compared with use of conventional CT guid-ance.