Brachial plexus block for cancer-related pain: A case series

Abstract

Neoplastic brachial plexopathy (NBP) is caused by a cancerous infiltration into the brachialplexus, presenting often as severe pain in the affected upper extremity. Such pain can beresistant to medical treatment. Invasive interventions such as brachial plexus neurolysis withphenol or cordotomy may result in severe complications including permanent neurologicaldamage and death. Continuous brachial plexus and paravertebral block with local anesthetichave been reported to successfully control pain from NBP, but these techniques are logisticallychallenging and frequently have catheter-related complications.We report a series of patients who received single-shot brachial plexus blocks with a mixture oflocal anesthetic and corticosteroid (bupivacaine 0.25% with methyl-prednisolone 20 – 120 mg)for the treatment of refractory cancer-related pain in the brachial plexus territory, mostly fromNBP. Theoretically, such blocks could provide immediate analgesia from the local anesthetic anda longer-lasting analgesia from the slow-release steroids.Responders reported a sustained decrease in their pain (lasting from 2 weeks to 10 months),a significant decrease in their opioid and non-opioid (ketamine, gabapentin) consumption,overall satisfaction with the block, and unchanged or improved function of their limb. The idealcandidate for this procedure is a patient who has pain that is predominantly neuropathic froma lesion within the brachial plexus and with anatomy amenable to ultrasound-guided nerveblock.Our case series suggests that, in the appropriately selected patient, this technique can safelyand effectively alleviate pain from NBP. The procedure is simple, spares limb function, and canbe diagnostic, predicting response to more complex procedures. To the best of our knowledge,this is the first report using this technique for NBP.