title: Intrathecal neurolytic block in a patient with refractory cancer pain.
abstract: We report the successful treatment of refractory cancer pain by bilateral intrathecal neurolysis using phenol-glycerol. A 60-year-old man had recurrent sigmoid cancer and metastases to the lumbar (L4-5) and sacral bones. He complained of refractory pain in the lower back and lower extremities despite high-dose opioid treatment based on the WHO ladder. On admission to our hospital, he received continuous intravenous infusion of morphine (7,000 mg/day) with ketamine (300 mg/day) and lidocaine (700 mg/day). Intravenous midazolam was required to treat extreme anxiety. Because of inadequate pain relief and severe drowsiness, intrathecal phenol-glycerol neurolytic block was performed twice at the L2/3 intervertebral space. His analgesia was greatly improved and high-dose intravenous opioid was retitrated and ceased. He remained comfortable and lucid at home for 2 months, until 2 days before his death at hospital. Intrathecal neurolytic block may be appropriate for some patients suffering from refractory pain that is resistant to conventional opioid analgesic treatment.
authors.affiliation: Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. awatanab@sapmed.ac.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Watanabe
authors.forename: Michiaki
authors.initials: M
authors.lastname: Yamakage
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D005990:Glycerol / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010148:Intractable Pain / Q000188:drug therapy*; D019800:Phenol / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D019800:Phenol; D007649:Ketamine; D009020:Morphine; D005990:Glycerol