Open AccessTransversus Abdominis Plane Neurolysis with Phenol in Abdominal Wall Cancer Pain Palliation
Author(s) -
Rodolfo Gebhardt,
Kenneth K. Wu
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/e325
Subject(s) - medicine , neurolysis , cancer pain , surgery , intractable pain , nerve block , palliative care , opioid , cancer , abdominal surgery , anesthesia , abdominal pain , nursing , receptor
Pain is commonly perceived by patients during cancer and its treatment. Although mostpatients respond to conservative management implemented according to the World HealthOrganization guidelines, a subset of patients with advanced disease develop intractable painthat may require additional interventions such as regional blocks and intrathecal therapy.Patients with terminal abdominal or pelvic cancer who have high tumor burdens are oftenoffered a diagnostic visceral nerve block followed by neurolysis for pain palliation. Conventionalvisceral blocks usually require fluoroscopic guidance for correct needle placement in thevicinity of the neuroaxis or abdominal cavity. These techniques carry risks of injury to vessels,bowels, and nerves. Transversus abdominis plane (TAP) block is a technique that is easy toperform (particularly when ultrasonographic guidance is used), has a good safety record, andeffectively reduces pain levels and opioid requirements after abdominal and gynecologicalsurgery. Although numerous studies have demonstrated the effectiveness of TAP blocks inacute pain management, the role of TAP block in chronic pain management is very limited. Webelieve that chemical neurolysis with phenol can prolong the effects of analgesia in patientswith terminal cancer. We describe a case of terminal abdominal sarcoma with intractablepain that responded well to a TAP block followed by TAP neurolysis. The patient tolerated theprocedure well and demonstrated sustained analgesia for 45 days before dying of the disease.We also demonstrated that TAP block significantly reduces the total opioid requirement asdemonstrated by the morphine equivalent daily dose score after the neurolytic procedure. Thisresult supports our belief that TAP block with TAP neurolysis is an effective and inexpensivemodality that can be used to palliate intractable abdominal wall pain in patients with terminalabdominal cancer.Key words: Cancer pain management, phenol neurolysis, chemical neurolysis, transversusabdominis plane block, cancer pain palliation, intractable abdominal pain, ultrasound guided