The use of interpleural analgesia using bupivacaine for pain relief in advanced cancer

Abstract

The use of interpleural analgesia is described in six patients with a variety of advanced malignancies suffering from pain uncontrolled by opioids. The benefits and complications of the technique are discussed including management of the catheters at home and the measurement of plasma bupivacaine concentrations. Interpleural analgesia can provide good analgesia in a small, selected population of patients with otherwise uncontrolled pain of malignant origin.

Clinical Management of Pain in Advanced Lung Cancer

“…Nerve blocks may be useful for acute cancer pain such as intercostal nerve blockade for a pathological rib fracture. In order to prolong the analgesic effect, an infusion of local anesthetic adjacent to a neural plexus (eg, brachial plexus) or other nerves may be used 63,64…”

BTS statement on malignant mesothelioma in the UK, 2007

“…It is good practice to ensure that there is assessment of the needs of both the patient and the family or carers 136. Assessment of patients should include physical symptoms and physical functioning, psychological problems, social care needs and need for spiritual support.…”

Statement on malignant mesothelioma in the United Kingdom

“…If the pain is not easily and well controlled by these drugs, then referral to a pain relief service is advised, because other pain relief techniques can be useful. These will depend on local expertise and availability and include TENS machines, intercostal or paravertebral nerve blocks, interpleural,47 epidural or intrathecal analgesic infusions, local thoracic spine neurolytic blocks, or percutaneous cervical cordotomy 48. Localised pain associated with tumour invasion of the chest wall may respond to radiotherapy 36.…”