Neurolytic thoracic paravertebral block in cancer pain. A clinical report.
BACKGROUND
Paravertebral block has successfully been used in the treatment of acute and chronic pain. The duration of paravertebral block could theoretically be prolonged by using neurolytic agents.


METHODS
We retrospectively analyzed the results of neurolytic paravertebral blocks performed in 7 patients suffering from intense cancer-related thoracic pain. Thirty-seven spinal nerve roots were blocked during 20 visits. Nerve roots were identified by eliciting paresthesia radiating to the painful area. Each root was blocked separately. After test block using 0.5% bupivacaine, the paravertebral blocks were performed with 1-4 ml of 7% phenol in aqua.


RESULTS
No technical failures or complications were recorded in the patient files. Pain relief lasted over 2 months after 4 visits (20%), from 1 week to 1 month after 5 visits (25%), and less than 1 week after a single visit (5%). After 9 visits (45%), the results were poor with no significant pain relief.


CONCLUSIONS
Neurolytic paravertebral block with phenol doses used in our patients appears to have only limited use. Some patients with pain restricted to a small number of thoracic segments may benefit from its use. Because of complication risks, this technique should be limited to intractable pain in cancer patients with poor prognosis.
Antila
H
H
Department of Anaesthesiology, Turku University Central Hospital, Finland.
Kirvelä
O
O
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000188:drug therapy; D010148:Intractable Pain / Q000188:drug therapy* / Q000517:prevention & control; D010292:Paresthesia / Q000503:physiopathology; D019800:Phenol / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D013126:Spinal Nerve Roots / Q000187:drug effects; D013565:Sympatholytics / Q000008:administration & dosage / Q000627:therapeutic use*; D013900:Thoracic Nerves / Q000187:drug effects; D016896:Treatment Outcome
D000700:Analgesics; D000779:Anesthetics, Local; D013565:Sympatholytics; D019800:Phenol; D002045:Bupivacaine