156 - Cervical Subarachnoid Neurolytic Block

Abstract

Cervical subarachnoid neurolytic block is used primarily in patients with pain of malignant origin that is localized to one to three spinal segments and that has failed to respond to other conservative therapy. Because of the potential for serious complications, this technique is rarely used in patients with chronic benign pain, but it may be considered after a careful analysis of the risk-to-benefit ratio in carefully selected patients. This technique is most successful when the pain being treated is mediated by a limited number of spinal nerves; therefore, cervical subarachnoid neurolytic block has its greatest utility in the treatment of pain involving the upper extremity, such as the pain of Pancoast tumor or metastatic breast malignancy. Given the unique ability of this technique to allow destruction of the sensory component of the spinal root while theoretically sparing the motor component, this block procedure should probably be considered earlier in the course of a patient's disease than is currently being done. As with neurolytic celiac plexus block, the technique has a highly favorable cost-to-benefit ratio compared with the long-term administration of spinal opioids.