Continuous brachial plexus block as treatment for the Pancoast syndrome.
BACKGROUND
Six patients with severe neuropathic pain caused by a Pancoast tumor were treated with the continuous administration of local anesthetics. These patients had not responded to any other treatment, including nonsteroidal anti-inflammatory drugs, opioids, dexamethasone, tricyclic antidepressants, anticonvulsants, ketamine, and transcutaneous electric nerve stimulation.


METHODS
An axillary catheter was placed in the brachial plexus using a posterior approach that has not been described previously. A continuous infusion system of local anesthetics was delivered via a catheter. In two patients, the main purpose was to evaluate the technical possibilities and implications of this new approach. In all patients, the visual analogue scale score was evaluated until the patient died. In four additional patients, the quality of life and performance skills were recorded.


RESULTS
In all patients, there was a significant reduction in the visual analog scale score, and there was an increase in performance skills and quality of life in four patients. No side effects occurred from this technique or from the continuous administration of local anesthetics.


CONCLUSIONS
We conclude that neuropathic pain may be treated by local anesthetics administered through an axillary catheter placed in the brachial plexus. This technique is reversible and is preferable to destructive procedures such as cordotomy.
Vranken
J H
JH
Department of Anesthesiology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Zuurmond
W W
WW
de Lange
J J
JJ
D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D001365:Axilla; D001917:Brachial Plexus; D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000628:therapy; D002404:Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009437:Neuralgia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D010178:Pancoast Syndrome / Q000150:complications*; D017060:Patient Satisfaction
D000779:Anesthetics, Local