Ultrasound-Guided Erector Spinae Plane Block for Breakthrough Pancreatic and Hepatobiliary Malignancy Pain in the Emergency Department: A Case Series.

introductionBreakthrough pain is frequently experienced by patients with gastrointestinal malignancies and is a common reason for presenting to the emergency department (ED). After ruling out acute pathology, ED management typically consists of intravenous opioids, although high doses of opioids can be associated with potentially severe adverse events and complications in certain high-risk populations. Regional anesthesia strategies, such as the erector spinae plane block (ESPB), have been shown to be effective for several etiologies of non-malignant visceral abdominal pain. In this case series we sought to evaluate whether the ESPB can be effective for ED patients with breakthrough pancreatic and hepatobiliary cancer pain. CASE SERIES: Three patients with breakthrough hepatopancreatobiliary cancer pain underwent successful ESPBs performed by an emergency physician in the ED. All patients reported considerable reduction in their pain. Two patients with cancer of the pancreatic head reported complete pain relief and were able to be discharged from the ED. The third patient with metastatic colorectal cancer involving the hepatobiliary system was admitted for further medical workup, although he did not require any additional analgesics for nearly 13 hours after the block.

conclusionThe erector spinae plane block appears to be a safe and effective strategy for managing breakthrough pain related to pancreatic and hepatobiliary malignancy in the ED.