Background and Aims Thoracic paravertebral is now an established regional anesthetic technique for unilateral surgical procedures or painful conditions. It has fewer complications when performed correctly.

Chronic pain is a significant concern in a cancer patient. Morphine has been used as a first-line analgesic strategy for severe pain. The effect of morphine on tumour growth is still contradictory, as both growth-promoting and growth-inhibiting effects have been observed. Accumulating evidence suggests that morphine can affect the proliferation and migration of tumour cells as well as angiogenesis (1)

Methods We report here the use of Ultrasound-guided right side thoracic paravertebral block at the level of T2 and T9 for severe back pain, right side chest wall and right side abdominal wall pain of T2 and T9 dermatomes in 56 years old male patient, known case of acute myeloid leukemia (AML-M2) found to have right side thoracic paravertebral masses at levels of T2 and T9.

The 19-gage Tuohy needle inserted USG In-plane, after penetration of internal intercostal membrane 0.25% bupivacaine 20 ml with dexamethasone 4 mg was injected after negative aspiration of blood or air. Total amount: 40 ml of 0.25% Marcaine (20 ml each injection) with Dexamethasone total of 8 mg.

Results During the block procedure, no difficulty of breath or desaturation occurred and no hemodynamic change occurred.

In the PACU, the patient was comfortable and free of pain then discharged home. He remains pain-free for 2 days.

Conclusions Thoracic paravertebral block is an alternative of morphine for chronic pain caused by thoracic paravertebral mass.