Long-term continuous erector spinae plane block for palliative pain control in a patient with pleural mesothelioma

Our plain-English summary of Long-term continuous erector spinae plane block for palliative pain control in a patient with pleural mesothelioma, by J. Ramos, P. Peng, M. Forero (Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie, 2018).

The study

• Authors: J. Ramos, P. Peng, M. Forero
• Journal: Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
• Published: 2018;65(7):852-853
• Type of article: Case report, Letter
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter described a continuous erector spinae plane (ESP) block used for palliative pain control in malignant pleural mesothelioma. The authors noted that no earlier reports had outlined this use in the outpatient setting. The patient was a 57-year-old woman with a four-month history of the disease and severe chest wall pain radiating to the right shoulder despite 80 mg of intravenous morphine per day. An ultrasound-guided diagnostic ESP block at T3 with 20 mL of 0.5% bupivacaine reduced her pain from 6 to 2 on a 0-10 scale within 30 minutes. A catheter was then placed at T2, with its tip aimed at T3. Boluses of 5 mL 0.5% bupivacaine every eight hours allowed morphine to be reduced to 50 mg per day, and she could walk comfortably with a resting pain score of 2/10. A three-day trial of continuous infusion by elastomeric pump did not give the same relief. Boluses of 10 mL 0.25% bupivacaine every eight hours, given by her husband, were therefore restored, and morphine was reduced to 40 mg per day without rescue doses. The catheter remained in place without adverse events until she died of disease progression 66 days later. The authors concluded that the technique provided long-term analgesia and improved quality of life, and that further study of its effectiveness and safety in outpatients is needed.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This case report described one 57-year-old woman with a four-month history of malignant pleural mesothelioma. Severe chest wall pain spreading to her right shoulder had not responded to conventional treatment, including 80 mg of intravenous morphine per day. The authors gave her an ultrasound-guided erector spinae plane (ESP) block, injecting the local anesthetic bupivacaine beside the spine. Thirty minutes after a first test block, her pain score fell from 6 to 2 on a 0-to-10 scale. A catheter was then placed. With doses through it every eight hours, her morphine was cut from 80 to 50 mg per day and she could walk comfortably. A continuous pump infusion did not give the same pain relief, so her husband resumed giving doses every eight hours, and morphine fell to 40 mg per day. She kept the catheter without adverse events until she died of disease progression 66 days later. The authors concluded that the catheter gave uneventful long-term pain relief and improved her quality of life. They added that further study of the method's effectiveness and safety in outpatients is required.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (published as a letter to the editor)
• Who was studied: One 57-year-old woman with a four-month history of malignant pleural mesothelioma and severe chest wall pain radiating to the right shoulder. Her pain had not responded to conventional analgesia. The letter does not state where or when she was treated.
• Exposure: No asbestos exposure history is reported. The report concerns a pain treatment: an ultrasound-guided erector spinae plane block at T3 with 20 mL of 0.5% bupivacaine. This was followed by an indwelling catheter for repeated bupivacaine doses.
• Main results:
  • Thirty minutes after the first (diagnostic) block, the patient's chest wall and shoulder pain fell from 6 to 2 on a 0 to 10 numerical rating scale. She needed no rescue analgesic that night and slept well.
  • With 5 mL boluses of 0.5% bupivacaine through the catheter every eight hours, intravenous morphine was reduced from 80 to 50 mg per day without rescue morphine. The patient could walk comfortably with a resting pain score of 2 out of 10.
  • A pinprick test showed sensory block from T3 to T9 on the right side of the chest.
  • Switching to a continuous infusion with an elastomeric pump (maximum 5 mL per hour over three days, up to 0.2% bupivacaine) did not reproduce the same pain relief.
  • Her husband resumed intermittent boluses of 10 mL of 0.25% bupivacaine every eight hours. This gave adequate pain control, morphine fell from 50 to 40 mg per day, and no rescue morphine was needed.
  • The catheter stayed in place without adverse events until the patient died of continued disease progression 66 days later.
• The authors' conclusion: The authors concluded that continuous ESP delivery through a catheter provided uneventful, long-term pain relief and improved quality of life in this patient with chest pain from advanced mesothelioma. They also stated that further study is required.
• Limitations the authors state:
  • The authors stated that further study is required to examine the effectiveness and safety of the continuous block in the outpatient setting.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Palliative Care, Pleural Mesothelioma, Ultrasound, Disease Progression, Quality of Life.

Related studies

• Ultrasound guided continuous erector spinae plane block for pain management in pulmonary malignancy — T. Aydın, O. Balaban, et al. (2018)
• Unexpected complication of successful nerve block. Morphine induced respiratory depression precipitated by removal of severe pain — G.W. Hanks, R.G. Twycross, et al. (1981)
• Percutaneous cervical cordotomy for cancer-related pain: national data — M. Poolman, M. Makin, et al. (2020)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• Chest pain and ST elevation: not always ST-segment-elevation myocardial infarction — S.A. Pyxaras, G. Lardieri, et al. (2010)
• Chest pain in asbestos and silica-exposed workers — E.K. Park, P.S. Thomas, et al. (2011)

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