Neurolytic Erector Spinae Plane Block for Long-Term Oncologic Pain Control: A Report of Two Cases

Background: The erector spinae plane block (ESPB), a novel interfascial plane block initially intended for the management of severe thoracic neuropathic pain by Forero et al, is currently used for many other peri- and post-operative procedures due to its simplicity and safety. Recent numerous studies have demonstrated the effectiveness of ESP blocks in acute pain management, using local anesthetics for their realization, but the true mechanism of action of this block has not yet been determined due to a paucity of evidence of the technique, so the role of ESPB in chronic pain management is limited. Even more, there are no studies using neurolytic techniques in the ESPB. Method: We describe the successful application of the neurolytic substance phenol in 2 female patients with severe pain due to breast cancer where the previous management of the analgesic medications, did not achieved an adequate pain control. Result: The neurolytic-ESPB produced an extensive multidermatomal sensory block, allowing the reduce of the previous total oral opioid requirement for prolonged periods of time after the neurolytic procedure, and reducing, in consequent, the related side effects, improving the quality of life of our patients. Conclusion: The true mechanism of ESPB has not yet been determined, and there is a paucity of evidence of its role in the management of chronic pain with this technique. This balance between effectiveness and safety in all areas of chronic pain, mainly with patients with refractive cancer-pain, where multimodal techniques are chosen, must follow the criteria of evidence-based medicine.