Disclosures: Marine Dididze, MD, PhD: Nothing to disclose

Case Description: Patient presented with chronic cervicalgia with constant pain 6/10 radiating to the left shoulder and arm. MRI revealed left apical lung mass with destruction of first rib tightly juxtaposed to the left brachial plexus, which was likely contributing to his pain and tumor extension through the left intervertebral foramina at C7-T1 and T1-T2. Prior to this presentation he failed C6-C7 epidural steroid injection and left cervical medial branch nerve block. Due to MRI findings, he was not a candidate for a spinal cord stimulator or intrathecal drug delivery system implantation. The decision was made to perform intrapleural neurolysis with diagnostic block to be completed prior to the neurolytic block.

Setting: Inpatient Rehabilitation Department of an Academic Medical Center

Patient: A 65-year-old male with lung cancer on chemotherapy.

Assessment/Results: Focused neurological exam of the left upper extremity revealed decreased motor strength MRC (Medical Research Council) grade 4/5 and decreased sensation to light touch in C6-T1 segments. Initially patient underwent placement of epidural catheter at the T6 rib level using fluoroscopy in a sitting position and intrapleural injection with 20 mL 1% lidocaine. Then patient was positioned in the deep Trendelenburg right-sided position, monitored and re-assessed after 30 minutes. He endorsed 100% pain relief in his upper extremities, 50% pain relief in his neck and motor strength improved to MRC grade 5/5 in left upper extremity except wrist extensors and finger flexors (MRC grade – 4/5, sensation remained the same. Successful diagnostic block was followed by neurolysis with injecting 20 mL 98% alcohol. The patient tolerated the procedure well with no complications, reporting 100% pain relief after the procedure.

Discussion: To our knowledge this is the first reported case of intrapleural neurolysis for pain caused by brachial plexus metastatic tumor.

Conclusion: Intrapleural neurolysis is an option for patients with brachial plexus cancer pain who fail other modalities.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-unique-case-of-intrapleural-neurolysis-for-brachial-plexus-cancer-pain/