title: Neurolytic transversus abdominal plane block with alcohol for long-term malignancy related pain control.
abstract: There have been several case reports in the literature of neurolytic transversus abdominis plane (TAP) blocks being used for malignant abdominal wall pain. However, most used phenol as a neurolytic agent. We found only a single case report by Sakamoto using alcohol for TAP neurolysis. Unfortunately this patient passed away only 5 days after performance of the block. We attempt to extend upon the existing literature by describing neurolytic TAP blockade outcomes using alcohol on 3 cancer patients with metastatic disease to the abdominal wall. Two of our 3 patients had colorectal cancer invading the abdominal musculature. The third patient had a metastatic neuroendocrine nodule in the left rectus muscle. In our case series, all 3 patients had sustained and significant (greater than 50%) relief of abdominal wall pain after performing TAP neurolysis using alcohol. Ultrasound guidance was used for all blocks. The concentration of alcohol used varied from 33% to 77% between patients. Duration of relief lasted between 17 days and 6 months. Opioid use either decreased or remained relatively stable for prolonged periods of time after neurolysis. Other than one patient with transient post-procedure pain related to alcohol injection, there were no significant complications. Addition of a depo steroid for diagnostic TAP blockade prior to neurolysis did not appear to extend or provide additional analgesia. Based on our observations, TAP neurolysis using alcohol also offers a feasible option for long-term control of malignant abdominal wall pain. Further investigation is needed to determine if alcohol offers any significant advantage compared with phenol.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Hung
authors.forename: Nyla
authors.initials: N
authors.lastname: Azam
authors.forename: Vinay
authors.initials: V
authors.lastname: Puttanniah
authors.forename: Vivek
authors.initials: V
authors.lastname: Malhotra
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY; New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Gulati
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology; D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology*; D000431:Ethanol / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009407:Nerve Block / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000700:Analgesics; D000431:Ethanol