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Background and Aims The analgesic cornerstone in cancer pain are opioids(1), in some cases interventional-pain-management is recommended(2). The Quadratus lumborum block(QLB) has shown benefits for abdominal wall(3), parietal and neuropathic pelvic pain(4). Its analgesic extends effect from T7-L1(5) this is explained by the relationship between the transverse fascia and the endothoracic fascia(6). Safety of phenolization has been described in cancer(7). We present a case report of QL2 phenolization for cancer pain.

Methods This is a case of a 66-year-old male patient with malignant colonic cancer, metastatic to pancreas, spleen and abdominal wall, with intractable severe pain. A diagnostic QLB-2 was proposed because he refused any continuous neuraxial procedure. We proceeded under ultrasound-guide, in plane with a sham-rock approach, with 20mL bupivacaine 0.5% with 50 mg of triamcinolone (figure 1A). After 48 hours a neurolytic phenol injection was administered, with identical technique only bupivacaine was replaced by 20ml phenol 10%. (figure 1B).

Results The patient’s reported 70% d dynamic and 80% on static decrease in pain on VAS for 48 hours and 42% oxycodone daily dose reduction with QL-2 block, 80% decrease in dynamic and 90% at rest pain during 10 days and 40% reduction in oxycodone dose with neurolysis. Unfortunately, due cluster symptoms he required intermittent sedation 2 weeks and past away.

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Abstract #35519 Figure 1

A: EOM: external oblique muscle, IOM internal oblique muscle, TM transverse muscle, QLM quadrates lumborum muscle. B: ultrasound guidance showing free liquid around needle tip. C: CT scan shows abdominal wall metastatic collections

Conclusions This case is a novel use for QLB-2 as an anatomical target for neurolytic procedures for abdominal cancer pain relief. Further trials are needed for to highlight the role of this procedure for a more widespread use.

Attachment Phenol neurolysis QL-2.pdf