Disclosures: Vivek Mukherjee, MD: No financial relationships or conflicts of interest

Case Diagnosis: A patient with right-sided malignant pleural effusion presents with severe ipsilateral thoracic pain after PleurX removal.

Case Description: A 64-year-old male with PMH of prostate cancer and asbestos exposure presented to his PCP with right-sided rib pain. CT chest revealed a right-sided loculated pleural effusion with parenchymal pulmonary metastases. Thoracocentesis confirmed poorly differentiated metastatic lung adenocarcinoma. He underwent placement of a PleurX catheter to drain the effusion. The catheter was removed one month later due to ineffective placement raising the risk of infection. After the catheter removal, he developed severe right-sided thoracic pain unresponsive to tramadol, oxycodone, and dilaudid. He was referred to the pain medicine clinic for evaluation. He demonstrated severe pain in the right T4-T8 nerve root distributions that worsened with repetitive movements of the right arm and deep breathing. He was taken to the fluoroscopy suite where he underwent an ultrasound guided erector spinae plane block to the right T7 paraspinal level with a mixture of 0.5% lidocaine, 0.5% bupivacaine, and 10 mg dexamethasone. He responded well to the injection and reported relief after the procedure.

Setting: Outpatient office and fluoroscopy suite at academic institution.Assessment/

Results: Ultrasound guided erector spinae plane block to the right T7 paraspinal level resulted in relief of thoracic pain caused by the combination of a malignant pleural effusion and pleural irritation after PleurX catheter removal.

Discussion: Managing thoracic pain in cancer patients is multidisciplinary, involving oncology, thoracic surgery, radiology, pain medicine, radiation therapy, and palliative care. The joint efforts of different disciplines can improve patients’ quality of living. In addition to medication, pain specialists can offer acute interventional procedures such as regional anesthesia, epidural analgesia, intrathecal pumps, and neuroablation for cancer pain.

Conclusion: We report a case in which an erector spinae plane nerve block was successfully used to treat cancer related thoracic neuralgia unresponsive to post-surgical pain medications.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/interventional-management-of-thoracic-pain-secondary-to-malignant-pleural-effusion-a-case-report/