Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases

Jose Correa; Henry Cortes; Patricia Abella; Alberto Quevedo; Olga Correa

doi:doi:10.11648/j.ijacm.20200802.12

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Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases

Jose Correa, Henry Cortes, Patricia Abella, Alberto Quevedo, Olga Correa

Received: 25 July 2020 Accepted: 7 August 2020 Published: 13 August 2020

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Abstract

Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.

DOI	10.11648/j.ijacm.20200802.12
Published in	International Journal of Anesthesia and Clinical Medicine (Volume 8, Issue 2, December 2020)
Page(s)	37-41
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Erector Spinae Plane Block, Chronic Cancer Pain, Interventional Nerve Block Procedures, Neurolytic Block

References

[1]	Pérez J., Oliver S., Rampakakis E., Borod M, Shir Y. The McGill University Health Centre Cancer Pain Clinic: A retrospectiveanalisys of an interdisciplinary approach to cancer pain management. Pain Res Management. 2016; ID 2157950.
[2]	Fallon M., Giusti R., Aielli F., Hoskin P., Rolke R., Sharma M>., Ripamonti C I., ESMO Guidelines Committee, Management of cáncer pain in adult patient: ESMO Clinical Practice Guidelines. Ann Oncol. 2018; 29 (4): 166-91.
[3]	Hochberg U., Elgueta MF., Pérez J., Interventional analgesic management of lung cáncer pain. Front Oncol. 2017 Feb 14; 7: 17. doi: 10.3389/fonc.2017.00017.
[4]	Greco MT, Roberto A, Corli O et al. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 2014; 32: 4149–4154.
[5]	Cleeland CS, Gonin R, Hatfield AK et al. Pain and its treatment in out-patients with metastatic cancer. N Engl J Med 1994; 330: 592–596.
[6]	Vissers KC, Besse K, Wagemans M et al. Pain in patients with cancer. Pain Pract 2011; 11: 453–475.
[7]	Hung JC, Azam N, Puttanniah V, Malhotra V, Gulati A. Neurolytic Trannsversus Abdominal Plane Block with alcohol for long-term Malignancy Related Pain Control, Pain Physician 2014; 17: E755-E760.
[8]	Lamer TJ. Treatment of cancer-related pain: when orally administered medications fail. Mayo Clin Proc 1994; 69: 473–480.
[9]	Vainio A, Tigerstedt I. Opioid treatment for radiating cancer pain: oral administration vs. epidural techniques. Acta Anaesthesiol Scand 1988; 32: 179–185.
[10]	Dworkin RH, O'Connor AB, Kent J, et al. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain. 2013; 154: 2249–2261.
[11]	Huygen F, Kallewaard J W, Van Tulder M, Van Boxem K, Vissers K, Van Kleef M, Van Zundert J. Evidence-based Interventional pain medicine according to clinical diagnoses: Update 2018. Systematic Review, GRADE, Recomendations.
[12]	Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-627.
[13]	Muñoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anesth 2017; 64: 880-2.
[14]	Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anesth 2018; 65: 288-93.
[15]	Bonvicini D, Giacomazzi A, Pizzirani E. Use of the ultra- sound-guided erector spinae plane block in breast surgery. Minerva Anestesiol 2017; 83: 1111-2.
[16]	Boohwi H, Seunguk B, Woosuk Ch, Subin Y, Jihyun C, Seoyeong K. Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a restrospective observational study. Korean J Pain. 2019 Jul; 32 (3): 206–214. DOI: 10.3344/kjp.2019.32.3.206.
[17]	Finneran JJ 4th, Gabriel RA, Khatibi B. Erector spinae plane blocks provide analgesia for breast and axillary surgery: a series of 3 cases. Reg Anesth Pain Med 2018; 43: 101-2.
[18]	Correa J, Abella P. Unidades del dolor del siglo XXI. ¿Protocolos de consenso o medicina basada en la evidencia? Pers. Bioét. 2018; 22 (1): 29-38 DOI: 10.5294/pebi.2018.22.1.3.
[19]	Elsharkawy H, Pawa A, Mariano ER. Interfascial Plane Blocks: Back to Basics. Regional Anesthesia & Pain Medicine 2018; 43: 341-346.
[20]	Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth. 2013 Nov; 111 (5): 721-35.
[21]	Mulvey MR, Rolke R, Klepstad P et al. Confirming neuropathic pain in cancer patients: applying the NeuPSIG grading system in clinical prac- tice and clinical research. Pain 2014; 155: 859–863.
[22]	Bennett MI, Rayment C, Hjermstad M et al. Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain 2012; 153: 359–365.
[23]	Sakamoto B, Kuber S, Gwirtz K, Elsahy A, Stennis M. Neurolytic transversus abdominis plane block in the palliative treatment of intractable abdominal wall pain. J Clin Anesth. 2012 Feb; 24 (1): 58-61.
[24]	Gebhardt R, Wu K. Transversus abdominis plane neurolysis with phenol in abdominal wall cancer pain palliation. Pain Physician. 2013 May-Jun; 16 (3): E325-30.
[25]	Lee KH, Kim DH, Kim YH, Ro SH, Lee J. Neurolytic abdominal wall blocks with alcohol for intractable gastrostomy site pain in a cancer patient. Korean J Anesthesiol. 2019 Apr 30. doi: 10.4097/kja.19041.
[26]	Vidal E, Gimenez H, Forero M, Fajardo M. Bloqueo del plano del musculo erector espinal: Estudio anatómico-cadavérico para determinar su mecanismo de acción. Rev Esp Anestesiol Reanim. 2018; 65 (9): 514-519.
[27]	Wood K. M., The use of Phenol as a Neurolytic Agent: A review. Pain. 1978; 5 (3): 205-229.
[28]	Altiparmak B., Korkmaz Toker M., Uysal Al, Gümüs Demirbilek S. Comparison of the efficacy of erector spine plane block performed with different concentrations of Bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial. BMC Anesthesiol. 2019 Mar 4; 19 (1): 31. DOI: 10.1186/s12871-019-0700-3.
[29]	Ramos J., Peng P., Forero M. Long-therm continuos erector spine plane block for palliative pain control in patient with pleural mesothelioma. Can J Anesth. 2018; 65 (7): 852-853.

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APA Style

Jose Correa, Henry Cortes, Patricia Abella, Alberto Quevedo, Olga Correa. (2020). Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases. International Journal of Anesthesia and Clinical Medicine, 8(2), 37-41. https://doi.org/10.11648/j.ijacm.20200802.12

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ACS Style

Jose Correa; Henry Cortes; Patricia Abella; Alberto Quevedo; Olga Correa. Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases. Int. J. Anesth. Clin. Med. 2020, 8(2), 37-41. doi: 10.11648/j.ijacm.20200802.12

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AMA Style

Jose Correa, Henry Cortes, Patricia Abella, Alberto Quevedo, Olga Correa. Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases. Int J Anesth Clin Med. 2020;8(2):37-41. doi: 10.11648/j.ijacm.20200802.12

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@article{10.11648/j.ijacm.20200802.12,
  author = {Jose Correa and Henry Cortes and Patricia Abella and Alberto Quevedo and Olga Correa},
  title = {Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {8},
  number = {2},
  pages = {37-41},
  doi = {10.11648/j.ijacm.20200802.12},
  url = {https://doi.org/10.11648/j.ijacm.20200802.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200802.12},
  abstract = {Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.},
 year = {2020}
}

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TY  - JOUR
T1  - Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases
AU  - Jose Correa
AU  - Henry Cortes
AU  - Patricia Abella
AU  - Alberto Quevedo
AU  - Olga Correa
Y1  - 2020/08/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijacm.20200802.12
DO  - 10.11648/j.ijacm.20200802.12
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 37
EP  - 41
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20200802.12
AB  - Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.
VL  - 8
IS  - 2
ER  -

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Author Information

Jose Correa

Department of Anesthesia, Fundación Universitaria JN Corpas, Bogotá, Colombia
Henry Cortes

Department of Anesthesia, Fundación Universitaria JN Corpas, Bogotá, Colombia
Patricia Abella

Department of Anesthesia, Fundación Universitaria JN Corpas, Bogotá, Colombia
Alberto Quevedo

Department of Anesthesia, Hospital Universitario Virgen de Las Nieves, Granada, Spain
Olga Correa

RN CMSRN, Baptist Health South Florida, Miami, USA

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Jose Correa, Henry Cortes, Patricia Abella, Alberto Quevedo, Olga Correa. (2020). Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases. International Journal of Anesthesia and Clinical Medicine, 8(2), 37-41. https://doi.org/10.11648/j.ijacm.20200802.12

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ACS Style

Jose Correa; Henry Cortes; Patricia Abella; Alberto Quevedo; Olga Correa. Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases. Int. J. Anesth. Clin. Med. 2020, 8(2), 37-41. doi: 10.11648/j.ijacm.20200802.12

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AMA Style

Jose Correa, Henry Cortes, Patricia Abella, Alberto Quevedo, Olga Correa. Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases. Int J Anesth Clin Med. 2020;8(2):37-41. doi: 10.11648/j.ijacm.20200802.12

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@article{10.11648/j.ijacm.20200802.12,
  author = {Jose Correa and Henry Cortes and Patricia Abella and Alberto Quevedo and Olga Correa},
  title = {Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {8},
  number = {2},
  pages = {37-41},
  doi = {10.11648/j.ijacm.20200802.12},
  url = {https://doi.org/10.11648/j.ijacm.20200802.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20200802.12},
  abstract = {Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases
AU  - Jose Correa
AU  - Henry Cortes
AU  - Patricia Abella
AU  - Alberto Quevedo
AU  - Olga Correa
Y1  - 2020/08/13
PY  - 2020
N1  - https://doi.org/10.11648/j.ijacm.20200802.12
DO  - 10.11648/j.ijacm.20200802.12
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 37
EP  - 41
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20200802.12
AB  - Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.
VL  - 8
IS  - 2
ER  -

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