Neurolytic transversus abdominal plane block with alcohol for long-term malignancy related pain control

Pain Physician. Nov-Dec 2014;17(6):E755-60.

Abstract

There have been several case reports in the literature of neurolytic transversus abdominis plane (TAP) blocks being used for malignant abdominal wall pain. However, most used phenol as a neurolytic agent. We found only a single case report by Sakamoto using alcohol for TAP neurolysis. Unfortunately this patient passed away only 5 days after performance of the block. We attempt to extend upon the existing literature by describing neurolytic TAP blockade outcomes using alcohol on 3 cancer patients with metastatic disease to the abdominal wall. Two of our 3 patients had colorectal cancer invading the abdominal musculature. The third patient had a metastatic neuroendocrine nodule in the left rectus muscle. In our case series, all 3 patients had sustained and significant (greater than 50%) relief of abdominal wall pain after performing TAP neurolysis using alcohol. Ultrasound guidance was used for all blocks. The concentration of alcohol used varied from 33% to 77% between patients. Duration of relief lasted between 17 days and 6 months. Opioid use either decreased or remained relatively stable for prolonged periods of time after neurolysis. Other than one patient with transient post-procedure pain related to alcohol injection, there were no significant complications. Addition of a depo steroid for diagnostic TAP blockade prior to neurolysis did not appear to extend or provide additional analgesia. Based on our observations, TAP neurolysis using alcohol also offers a feasible option for long-term control of malignant abdominal wall pain. Further investigation is needed to determine if alcohol offers any significant advantage compared with phenol.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / drug therapy*
  • Abdominal Pain / etiology
  • Analgesics / administration & dosage
  • Analgesics / pharmacology*
  • Ethanol / administration & dosage
  • Ethanol / pharmacology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Nerve Block / methods*
  • Treatment Outcome
  • Ultrasonography, Interventional

Substances

  • Analgesics
  • Ethanol