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Abstract
Background and Aims Intractable cancer-related chest wall pain is a challenging condition that significantly affects the quality of life for patients with advanced cancer. Traditional pain management approaches, such as opioids and adjuvant medications, may not provide adequate relief in some cases. This case report describes a 21-year old patient with intractable cancer-associated chest wall pain who was treated with intercostal nerve neurolysis. The patient was previously diagnosed with a rapidly growing unresectable Ewing sarcoma of the 7th rib and admitted for uncontrolled pain despite maximum tolerated dose of opioid and coanalgesic medication.
Methods First, a diagnostic ultrasound-guided nerve block of the 6th through 8th intercostal nerves was performed, using 1 mL of 2% lidocaine per level. Within 30 minutes there was a reduction in over 90% of the pain, deeming the block positive. This was followed by chemical neurolysis of the 6th through 8th intercostal nerves using 2 mL of 80% alcohol per level, under ultrasound guidance.
Results There was significant pain relief. No adverse events were observed. The patient was discharged 36 hours later with minimal pain. At one week follow-up the patient had persistent pain control with no need for rescue medication. Monthly follow-up was planned to evaluate long term analgesia.
Picture of the patient‘s chest demonstrating the extent of the tumor
The patient‘s chest contrast-enhaced computerized tomography scan depicting the loco-regional extent of the 7th rib Ewing sarcoma
Ultrasonography image capturing the intercostal nerve chemical neurolysis procedure, displaying the 6th intercostal space with the needle in situ following the injection of 2 mL of alcohol
Conclusions Although further research is needed to ascertain its efficacy and safety, current evidence suggests that intercostal nerve neurolysis can be a valuable tool in the multidisciplinary management of intractable cancer-related chest wall pain, offering relief and improving the quality of life for these patients.