Ultrasound guided continuous erector spinae plane block for pain management in pulmonary malignancy

Our plain-English summary of Ultrasound guided continuous erector spinae plane block for pain management in pulmonary malignancy, by T. Aydın, O. Balaban, A. Acar (Journal of Clinical Anesthesia, 2018).

The study

• Authors: T. Aydın, O. Balaban, A. Acar
• Journal: Journal of Clinical Anesthesia
• Published: 2018;46:63-64
• Type of article: Case report, Letter
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this letter, the authors, from the Department of Anesthesiology and Pain Medicine at Dumlupinar University Hospital in Kutahya, Turkey, described their use of a continuous ultrasound-guided erector spinae plane (ESP) block catheter to manage pain in two patients with pulmonary malignancies. The first patient was a 68-year-old man with lung cancer diagnosed three months earlier, with a primary mass at the right lung apex and sclerotic metastases at the T8–T9 vertebrae. Despite paracetamol, tramadol and a transdermal fentanyl patch, his chronic right chest and back pain scored 9/10 on a numerical rating scale (NRS). An ESP block was performed at the T2 level with 10 ml of 0.5% bupivacaine, and a catheter was placed and tunneled under the skin. Pain fell to 5/10 immediately and to 3/10 after one hour, and analgesia lasted 9 hours. Treatment continued with 10 ml of 0.25% bupivacaine through the catheter three times a day. On the second day, X-ray images after injection of radiopaque solution showed spread in the erector spinae plane. The second patient was a 40-year-old woman with left-sided mesothelioma of two years' duration and severe left chest and back pain (NRS 7–8/10, T2–T8 dermatomes) despite several analgesics. A catheter was placed at T6. After 10 ml of 0.5% bupivacaine, pain fell to 1–2/10, with 10 hours of analgesia, and treatment continued three times daily. The authors concluded that unilateral ESP block provided sufficient analgesia in end-stage pulmonary malignancy with severe unilateral thoracic pain, and that continuous ESP block seemed simple, with minimal procedural risk.

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 short letter to a journal, written by three authors from the anesthesiology and pain medicine department of Dumlupinar University Hospital in Kutahya, Turkey, described two patients. Both had cancer in the lung area and severe chest and back pain on one side. Under ultrasound guidance, a needle was placed beside the spine, a numbing drug (bupivacaine) was injected, and a thin tube (catheter) was left in for repeat doses. This method is called a continuous erector spinae plane (ESP) block. The first patient, a 68-year-old man with lung cancer that had spread to the spine, rated his pain 9 out of 10 before the block and 3 out of 10 one hour after, with relief lasting 9 hours. The second, a 40-year-old woman who had had mesothelioma on the left side of the lung for two years, rated her pain 7 to 8 out of 10 before and 1 to 2 out of 10 after, with 10 hours of relief. The letter did not discuss asbestos. The authors concluded that in these cases the one-sided block gave sufficient pain relief.

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: Letter to the editor (correspondence) describing two case reports
• Who was studied: Two patients at Dumlupinar University Hospital, Kutahya, Turkey: a 68-year-old man with lung cancer and spinal metastases, and a 40-year-old woman with mesothelioma on the left side of the lung for two years
• Exposure: No asbestos exposure was reported. The treatment described was an ultrasound-guided erector spinae plane catheter giving 10 ml of 0.5% bupivacaine, then 10 ml of 0.25% bupivacaine three times a day
• Main results:
  • Case 1 (68-year-old man with lung cancer): pain was 9/10 before the block, 5/10 immediately after, and 3/10 after 1 hour. Relief lasted 9 hours.
  • Case 2 (40-year-old woman with mesothelioma): pain was 7 to 8/10 before and 1 to 2/10 after 10 ml of 0.5% bupivacaine, with a 10-hour period of pain relief.
  • In Case 1, X-ray images taken after injecting a contrast solution through the catheter showed the solution in the erector spinae plane.
• The authors' conclusion: The authors concluded that, in their cases, a one-sided ESP block gave sufficient pain relief in patients with end-stage lung-area cancer and severe one-sided chest pain. They described the continuous block as a simple method with minimal procedural risk.

Topics

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

Medical terms in this study, explained in our Lexicon: Ultrasound, Lung Cancer, Mesothelioma.

Related studies

• Long-term continuous erector spinae plane block for palliative pain control in a patient with pleural mesothelioma — J. Ramos, P. Peng, 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)
• Interventional options for the management of refractory cancer pain--what is the evidence? — P. Vayne-Bossert, B. Afsharimani, et al. (2016)
• Physician-based ultrasound-guided biopsy for diagnosing pleural disease — R.J. Hallifax, J.P. Corcoran, et al. (2014)
• Ultrasound-guided pneumothorax induction prior to local anaesthetic thoracoscopy — J.P. Corcoran, I. Psallidas, et al. (2015)

Browse return to medical research.