COMBINATION OF INTRAPLEURAL, EPIDURAL AND BRACHIAL PLEXUS BLOCK FOR TREATMENT OF PAIN DUE TO LUNG CANCER

Abstract

S256 INTRODUCTION: Lung cancer involving the parietal pleura produces a sharp, piercing, knifelike pain. This pain radiates to the supraclavicular region, the shoulder area, the back and the area supplied by the intercostal nerve [1]. Intrapleural catheters are placed for continuous infusion or intermittent bolus administration of drugs relieves this pain [2]. Epidural blocks for back pain are also used. A retrospective study was performed on sixty seven cases of Lung cancer, who attended the pain relief centre for the treatment of pain at various sites of body over a period of 12 months. METHODS: 38 patients had severe pain in the chest, back, upper and lower limbs. 15 patients had pain in chest and back only and 14 patients had only back pain. All of these cases were on conventional medications with analgesics. After initial review and further trial of drugs according to WHO step ladder, these patients were given Intrapleural and Epidural blocks - either thoracic or lumber or both with catheters. Bupivacaine was used for Intrapleural block and a combination of Bupivacaine and Fentanyl for Epidural blocks. Following bupivacaine and fentanyl, absolute alcohol was used for Epidural neurolysis. 32 cases were given Supraclavicular brachial plexus block for pain in upper limb with bupivacaine and methyl prednisolone. RESULTS: All of these cases had pain relief for 3-7 months. Blocks were repeated in 5 cases within a month with positive results. CONCLUSIONS: Our observation from this study was that the combination of Intrapleural, Epidural and Brachial plexus block effectively control pain due to Lung cancer.