Intercostal administration of liposomal bupivacaine as a prognostic nerve block prior to phenol neurolysis for intractable chest wall pain

Chen Yin, Gerald Matchett

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Inadequate pain relief from systemic medications is common in patients with advanced malignancy. Chest wall pain secondary to tumor involvement of chest wall structures can be challenging to manage with systemic medications, and occasionally patients benefit from interventional procedures such as intercostal nerve blocks and neurolysis. In this report, the authors describe the case of a 58-year-old woman with advanced non-small cell lung cancer with tumor invasion into the third thoracic rib. After reaching maximum tolerated doses of transdermal fentanyl, oral hydromorphone, and oral ketamine, the patient elected for intercostal nerve blockade and neurolysis. Prognostic nerve blockade was performed using liposomal bupivacaine administered via intercostal approach. This formulation of bupivacaine provided an excellent prognostic blockade, which lasted for approximately 96 hours. This extended period of time allowed the patient to fully evaluate the prognostic blockade, prior to proceeding with neurolysis with phenol. This case suggests that liposomal bupivacaine may be a valuable adjunctive agent for prognostic blockade prior to neurolysis for cancer pain.

Original languageEnglish (US)
Pages (from-to)33-36
Number of pages4
JournalJournal of Pain and Palliative Care Pharmacotherapy
Volume28
Issue number1
DOIs
StatePublished - Mar 2014

Keywords

  • Cancer-associated pain
  • Intercostal nerve block
  • Liposomal bupivacaine
  • Phenol neurolysis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pharmacology (medical)

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