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The latest studies show biochemical and anatomopathologic changes that support the structural basis of the existence of transient neurologic syndrome. In the authors' view, transient neurologic syndrome could represent the lower end of a spectrum of local anesthetic toxicity. Recent findings demonstrate that nerve membrane damage induced by highly concentrated local anesthetics such as lidocaine, tetracaine, dibucaine and procaine may generate irreversible neural injury. Still further studies are needed to establish the relationship between morphological changes induced in vitro and the occurrence of clinical symptoms.

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In patients with aggressive tumors resistant to conventional pain treatment, regional anaesthesia frequently becomes an alternative therapy. Cervical paravertebral nerve block among several access options to the brachial plexus is barely ever used. We present a case with severe shoulder and upper extremity pain owing to an expanding Pancoast tumor exhibiting compression upon the brachial plexus. Continuous intrathecal morphine infusion and adjuvant treatment was not sufficient to render the patient pain-free. With the addition of paravertebral nerve blockade the patient's pain improved substantially, however without impacting his longevity.