Intermittent Erector Spinae Plane Block Via Subcutaneous Port for Cancer Pain

Cancer-related pain is a common and challenging problem in patients with lung cancer, often requiring long-term pain management. Conventional pain treatments, including systemic medications, may not provide adequate relief or may cause significant side effects. The erector spinae plane (ESP) block is a regional anesthesia technique that can help reduce pain by delivering local anesthetic near the nerves supplying the chest wall. This study aims to evaluate the effectiveness and safety of intermittent ESP block administered through a subcutaneous port for controlling cancer-related pain in patients with lung cancer. Eligible patients with lung cancer and moderate to severe pain will receive intermittent ESP block injections via a subcutaneous port as part of their pain management plan. Pain intensity, analgesic requirements, and potential side effects will be assessed over time. The results of this study may help determine whether intermittent ESP block via a subcutaneous port is a useful and feasible option for improving pain control and quality of life in patients with lung cancer.

Sex

All

Minimum age

18 Years

Inclusion Criteria

* Adult patients diagnosed with advanced-stage lung cancer who are currently receiving palliative care only.
* Presence of chronic cancer-related chest pain lasting longer than 1 month, localized to the thoracic region due to chest wall invasion, pleural involvement, or bone metastases.
* Performance status ≤ 3 according to the Eastern Cooperative Oncology Group (ECOG), allowing placement of a subcutaneous port and maintenance of local anesthetic administration.
* Inadequate pain control with conventional analgesic therapies or clinical indication for the addition of regional analgesia.
* Ability to understand the study procedures and provide written informed consent after receiving a full explanation of the intervention.

Exclusion Criteria:

* Chest pain with radiation to the upper extremities, neck, or shoulder, suggestive of non-localized thoracic pain.
* Severe hepatic or renal dysfunction, or severe heart failure (New York Heart Association class III-IV).
* Local infection at the injection or port placement site, or uncontrolled systemic infection.
* Severe cachexia or insufficient subcutaneous tissue that does not allow safe coverage of the subcutaneous port.
* Known allergy to amide-type local anesthetics or other contraindications to regional anesthesia.
* Severe cognitive impairment, altered consciousness, or inability to cooperate with post-intervention monitoring.
* Lack of adequate caregiver support for home-based follow-up after discharge or inability to coordinate follow-up with local healthcare facilities.
* Severe coagulation disorders, defined as:

  * International normalized ratio (INR) \> 1.5
  * Activated partial thromboplastin time (aPTT) \> 40 seconds
  * Fibrinogen \< 1.5 g/L
  * Platelet count \< 50 × 10⁹/L.

• BACKGROUNDFallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, Ripamonti CI; ESMO Guidelines Committee. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018 Oct 1;29(Suppl 4):iv166-iv191. doi: 10.1093/annonc/mdy152. No abstract available. PMID 30052758
• BACKGROUNDKot P, Rodriguez P, Granell M, Cano B, Rovira L, Morales J, Broseta A, Andres J. The erector spinae plane block: a narrative review. Korean J Anesthesiol. 2019 Jun;72(3):209-220. doi: 10.4097/kja.d.19.00012. Epub 2019 Mar 19. PMID 30886130
• BACKGROUNDForero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7. doi: 10.1097/AAP.0000000000000451. PMID 27501016