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Background and Aims Malignant psoas syndrome (MPS) is associated with proximal lumbosacral plexopathy and characterized by severe intractable pain, despite multi- modal medical treatment. Spinal dexmedetomidine and lumbar sympathetic nerve block in combination with Pulsed radiofrequency (PRF) are rarely performed for intractable lumbosacral plexopathy pain. We present a combination of spinal dexmedetomidine, lumbar sympathetic nerve block and caudal- epidural PRF in the management of MPS, refractory to medical and physical treatment.
Methods A 49-years old female with recurrent lung adenocarcinoma, admitted with severe shooting and burning right groin pain with radiation to the thigh and weakness of quadriceps at motion. She was managing her pain with number of opioids, including oxycodone, morphine, fentanyl, and intramuscular meperidine. The total oral morphine equivalent opioid dose equaled 300-400 mg. For the first month after admission, we successfully palliated pain with spinal dexmedetomidine and simultaneously reduced patient’s opioid addiction. On the second month, bilateral lumbar sympathetic plexus block at L3-L4 with additional caudal-epidural PRF, led to significant reduction in her thigh pain VAS score to 4/10. In addition, improvement in quadriceps functionality and sleep quality, along with remarkable reduce in analgesic opioid doses, earned patient high satisfaction.
Results Intrathecal dexmedetomidine infusion allowed successful pain resolution with average VAS of 3-4/10 for 1 month. Caudal-epidural PRF with sympathetic block sustained painless palliative period at stable VAS of 4-5/10.
Conclusions Spinal dexmedetomidine, caudal-epidural PRF and lumbar sympathetic plexus block can be an innovative therapeutic option in the management of Malignant psoas syndrome, acquired due to lumbosacral plexopathy.
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