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Abstract
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Background and Aims Severe pain is a prevalent problems associated with advanced oncological disease. Interventional pain management as nerve blocks, neurolysis, or placement of epidural and peripheral catheters with drug infusions has been shown to improve pain control and decrease the need for systemic opioids. Intrathecal neurolysis is a chemical destruction of the nerves; it aims to provide analgesia by administration of neurolytic substances in the subarachnoid space.
Methods A 47-year-old female patient with a history of a metastatic colorectal adenocarcinoma, with rapid and progressive advance of the disease; therefore, she received multiple therapeutic and interventional options to relieve pain, was refractory to different drug combinations and interventions, at fisical exam she had advanced terminal disease with motor involvement in the lower limbs secondary to tumor infiltration, with a muscle strength of 2/5 in the left lower limb and 3/5 in the right lower limb, had a derivative colostomy and urinary catheter
Results By prone midline approach, the L5–S1 intervertebral level was located in an AP view, a needle was inserted into the subarachnoid space, was confirmed with contrast medium, and return of cerebrospinal fluid (CSF) was observed, 2 ml of 96% absolute alcohol was injected very slowly, and the patient was kept in the prone position for 30 min. The procedure was performed without complications.
Patient in prone position to obtain AP projection. Patient in prone position with the needle positioned at the intervention site. Prone position intended to bathe the posterior (sensory) nerve roots with hypobaric ethanol
Simple coronal CT scan, large tumor lesion extending towards the left gluteus
Conclusions This is an accessible and cost-effective procedure, its use should be encouraged, since it could be a helpful alternative for the management of patients with refractory pain in the terminal stage.