Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.037
Brazilian Journal of Anesthesiology
Case Report

Ultrasound-guided pericapsular nerve group and obturator nerve phenol neurolysis for refractory inpatient hip cancer metastasis pain: a case report

Grupo de nervos pericapsulares guiado por ultrassom e neurólise com fenol do nervo obturador para dor refratária de metástase de câncer de quadril em paciente internado: relato de caso

Marcio V. Pimenta, Amanda T. Nakamura, Hermann S. Fernandes, Joaquim E. Vieira, Hazem A. Ashmawi

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Abstract

Introduction
Bone cancer metastasis may produce severe and refractory pain. It is often difficult to manage with systemic analgesics. Chemical neurolysis may be an effective alternative in terminally ill patients.

Case report
The study included 40 patients randomly allocated into two groups: sub-Tenon’s blockade with Lidocaine plus Saline Solution (LS) or Lidocaine plus Clonidine (LC). IOP, OPA and OPP were measured before anesthesia, and 1, 5 and 10 minutes after the injection of anesthetic solution.

Discussion
This approach may be effective and safe as an analgesic option for refractory hip pain due to metastasis or pathologic fracture in terminally ill patients.

Keywords

Regional anesthesia;  Pain management;  Chemical neurolysis; Hip;  Metastasis

Resumo

Introdução

A metástase do câncer ósseo pode produzir dor intensa e refratária. Muitas vezes é difícil lidar com analgésicos sistêmicos. A neurólise química pode ser uma alternativa eficaz em pacientes terminais.

Relato de caso

Paciente terminal do sexo feminino com metástase de câncer gástrico no quadril com dor intensa. Bloqueios neurolíticos guiados por ultrassom do grupo de nervos pericapsulares e do nervo obturador foram realizados com fenol a 5%. Isso levou ao alívio satisfatório da dor por 10 dias, até o óbito do paciente.

Discussão

Esta abordagem pode ser eficaz e segura como opção analgésica para dor refratária no quadril devido a metástase ou fratura patológica em pacientes terminais.

Palavras-chave

Anestesia regional; Manejo da dor; Neurólise química; Metástase de quadril

References

1. Christmas C, Crespo CJ, Franckowiak SC, et al. How common is hip pain among older adults? results from the third national health and nutrition examination survey. J Fam Pract. 2002;51:345–8.

2. Mantyh PW. Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care. 2014;8:83–90.

3. Giron-Arango L, Peng PWH, Chin KJ, et al. Pericapsular Nerve Group (PENG) block for hip fracture. Reg Anesth Pain Med. 2018;43:859–63.

4. Nielsen TD, Moriggl B, Soballe K, et al. A cadaveric study of ultrasound-guided subpectineal injectate spread around the obturator nerve and its hip articular branches. Reg Anesth Pain Med. 2017;42:357–61.

5. Kwun-Tung Ng T, Chan WS, Peng PWH, et al. Chemical hip denervation for inoperable hip fracture. Anesth Analg. 2020;130:498–504.

6. Rocha Romero A, Carvajal Valdy G, Lemus AJ. Ultrasound-guided pericapsular nerve group (PENG) hip joint phenol neurolysis for palliative pain. Can J Anaesth. 2019;66:1270–1.


Submitted date:
09/24/2020

Accepted date:
02/06/2021

605e2b69a953957b0b4cee02 rba Articles
Links & Downloads

Braz J Anesthesiol

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